
Book g3 



GopyiightN" 



'1" 



COPYRiGEiT DEPOSIT. 



THE HYGIENE OF 
THE SCHOOLROOM 



BY 

WILLIAM F. BARRY, M. D., 

MEMBER OF THE SCHOOL BOARD, CITY OF WOONSOCKET, R. I, 

VISITING PHYSICIAN TO WOONSOCKET HOSPITAL ; CONSULTING 

PHYSICIAN TO ST. JOSEPH'S HOSPITAL, PROVIDENCE, R. I. 

MEMBER OF THE AMERICAN MEDICAL ASSOCIATION. 



Revised Edition 




SILVER, BURDETT AND COMPANY 
NEW YORK BOSTON CHICAGO 






COPYRIGHT, 1903, BY 

SNOW AND FARNHAM 

COPYRIGHT, 1904, 1909, 191 I, BY 

SILVER, BURDETT AND COMPANY 



^ i.0>;: 



©ClA303:>7i 



" Pf7/«/ zvill it profit a child to gain the whole 
ivoi^ld of knowledge and lose his oivn health ? " 



PREFACE 



The aim of the author in writing this book is to place 
in the hands of educators and others interested in child 
life trustworthy knowledge of the means of conserving 
the health of those entrusted to their care. Compulsory 
education, in this country, is almost universal, and it 
should be the duty of the authorities to see that in the 
schools which children are required to attend nothing 
of an unhygienic nature exists. It is the truth, however, 
that until very recently little attention was given to the 
physical side of the child's nature, and that in the school- 
room the fundamental principles of hygiene were very 
little understood — at least were not practised. Some 
matters, to be sure, that concern the pupil's health, such 
as the need of proper diet, of proper clothing, and of 
eye-glasses, are beyond the province of the school author- 
ities, and can be reached only by advice to parents and 



vi Preface. 

guardians. But many of the evils growing out of a 
common public school system are remediable : there can 
be, for example, better treatment of the problems of 
heating, ventilating and lighting. Upon these and kin- 
dred topics this book offers suggestions which the writer 
trusts will be ol value to whoever is interested in improv- 
ing the physical condition of the children in our schools. 
A work of this nature is essentially for teachers, super- 
intendents and school governing boards, and aims in all 
parts to be practical rather than to quote countless pages 
of statistics usually as various as the individual opinions 
of the writers. The author hopes to combine the con- 
sensus of the best opinion with personal knowledge and 
investigation and make clearer the much discussed sub- 
ject of School Hygiene. 



Preface to Second Edition 



The encouraging- manner in which the first edition of 
"The Hygiene of the Schoolroom" was received has im- 
portance, principally, in showing a lively interest in all 
that tends to the pupil's physical well being. 

School officials, generally, are evincing commendable 
concern in the modern construction of school buildings, 
ventilation, heating, lighting, school diseases, medical in- 
spection and kindred subjects. 

In many cities through their efiforts medical super- 
vision has been adopted, and, its benefits being so ap- 
parent and immediate, it has always found lasting favor. 

Teachers have appreciated this volume as a reference 
book,' as i't makes their duty much clearer in many per- 
plexing points of a scientific nature, which they must de- 
cide upon, yet which demand almost an expert's under- 
standing. 

As promised in the prospectus at the beginning of the 
year, the book was to be a practical treatise on all that 



viii Preface to Third Edition. 

pertains to the heahh of the pupil. Upon its appear- 
ance it was eagerly taken up by educators throughout 
the country, many of whom have expressed their grati- 
tude for the helpfulness it affords in the field it covers. 
Many, too, have added to the value of the second edition 
by timely suggestions and comment. 

It is hoped that this book will help to keep alive the in- 
terest that is being felt in the preservation and promotion 
of the pupil's physical welfare. 

The author trusts that it will be received with the same 
favor and appreciative criticism that was accorded the 
first edition. 

WOONSOCKET, R. I., Nov. I, I904. 



Preface to Third Edition 

The author is glad of this opportunity to offer an en- 
larged " Hygiene of the Schoolroom " in the third edition. 

In six years school hygiene has taken hfe and energy 
in such measure as has been accorded no other depart- 
ment of child life study. If this work has been helpful 
in this impetus, the author counts himself well repaid, 
and if one child has been spared disease, he feels that 
his life work has not been in vain. 

WooNsocKET, R. I., June i, 1909. 



CONTENTS 



CHAPTER I 

PA !• 

The Selection of a Site for a School Building i 

CHAPTER H 
The Construction of School Buildings . 4 

CHAPTER HI 
Ventilation . . . . . .17 

CHAPTER IV 
Heating ....... 30 

CHAPTER V 
School Furniture . . . . -35 

CHAPTER VI 

Light . . . . . . • ' 57 

CHAPTER VII 
The Hygiene of ti-ie Eye .... 64 

CHAPTER VIII 
The Hygiene of the Ear .... 82 

CHAPTER IX 



The Vocal Organs 



90 



X Contents. 

CHAPTER X 

PAGE 

Relation of Contagious Diseases to the School 98 

CHAPTER XI 

Medical Inspection of Schools . . . 126 

CHAPTER XII 
Modern Education and Health . . . 141 

CHAPTER XIII 
School Diet 157 

CHAPTER XIV 
Physical Training and Exercise . . 163 

CHAPTER XV 
Corporal Punishment 168 

CHAPTER XVI 

Sickness and Accident in the Schoolroom . 175 

CHAPTER XVII 
The Teacher's Health 182 

CHAPTER XVIII. 
Defective Children 186 



LIST OF ILLUSTRATIONS. 



Page 

Fig. I. Standard school ward- 
robes in a school hall 7 

Fig. 2. A window ventilator 
made of glass 26 

Fig. 3. Illustrates a desk too 
high for a child 36 

Fig. 4. Illustrates too great 
space between the seat and 
desk 38 

Fig. 5. Illustrates a very com- 
mon fault in school furniture 40 

Fig. 6. Illustrates a too small 
" distance " between the seat 
and desk 42 

Fig. 7. Illustrates a desk and 
chair too small for pupil's 
size 44 

Fig. 8. Illustrates ill-fitting sta- 
tionary furniture 47 

Fig. 9. Chair and desk illus- 
trating proper seating of pupil 52 

Fig. id. Shows attention paid 
to light in schoolrooms built 
twenty-five years ago 58 

Fig. 1 1 . Shows modern 
school buildings plentifully 
supplied with windows 60 



Page 

Fig. 12. Diagram of the eye- 
ball 69 

Fig. 13. Shows the muscles of 
the eyeball in normal posi- 
tion 72 

Figs. 14, 15, 16. Show parallel 
rays entering the eye 73 

Fig. 18. Test for examining 
the eyes for hypermetropia 
or myopia 77 

Fig. 19. Test for examining 
the eyes for astigmatism. ... 78 

Fig. 22. View of the human 
ear 83 

Fig. 23. Photograph of a child 
suffering from adenoids .... 88 

Fig. 24. Photograph of a child 
from whose throat adenoid 
growths have been removed- 89 

Fig. 25. The larynx and adja- 
cent parts, as seen from 
above 91 

Fig. 26. Sanitary drinking 
fountain 116 

Fig. 27. Sanitary drinking 
fountain in use 118 



DEFINITIONS 



Hygiene is the branch of medical science which con- 
cerns the preservation of health. 

School Hygiene is the application of a system of prin- 
ciples or rules designed to preserve the health of the pupil. 



THE HYGIENE OF THE SCHOOLROOM 



CHAPTER I 

The Selection of a Site for a School Building. 

The selection of the site for, a school has an important 
bearing on the hygienic condition of the building. The 
primary consideration should be the drainage capacity of 
the soil; if possible, the land should be high and dry. 
Marshes or springy land must be avoided, else, although 
the greatest care in construction be taken, dampness in the 
cellar will most certainly result, and even if all the pre- 
cautions known to sanitary science are used in all other 
parts of the building, it will be impossible to overcome 
the evil effects of this dampness. There are many dis- 
eases which, while not due to dampness, are fostered and 
abetted by its presence, particularly diphtheria, typhoid 
fever, consumption and rheumatism. Headache and 
languor also frequently result from living in and breath- 
ing a damp atmosphere. 

An instance of unwise selection of a site is noted in a 
New England town, where a schoolhouse was built on a 



2 The Hygiene of the Schoolroom. 

side hill that was notoriously springy. More than twenty 
years have been spent unsuccessfully in trying to keep a 
dry cellar. Water forces itself in during the rainy season, 
filling the cellar bottom and leaving a grimy dampness on 
the side walls and a perceptible dampness in the rooms 
above. The result has been numerous complaints of 
rheumatism in the building and an unnecessarily high 
percentage of sickness. 

Made ground, that is, land that has been filled in with 
ashes, rubbish, and animal and vegetable refuse, is un- 
desirable school property. The air and moisture arising 
from such land are impregnated with foul and harmful 
gases, which are bound to make their way into the cellar ; 
and, for a number of years, at least until the refuse is 
entirely decomposed, make such a neighborhood unhealth- 
ful. Where possible, a good gravel soil should be se- 
cured; if this cannot be had, then, in order of preference, 
a sand soil and sandy clay. Clay retains moisture very 
readily, and when a cellar is dug in such soil it is more 
than likely to be a damp one. 

A school should be far from confusing noises, such as 
those made by railroad trains and certain factories. It 
is also unpleasant to be located near industrial establish- 
ments that constantly give ofif noxious odors. Further- 
more, the lot selected for a school building should be 



Site for a School Building. 3 

large enough to prevent neighboring structures from in- 
terfering with the necessary Hght. The building, as a 
general thing, should not cover more than half the lot. 
A good rule to follow is that no adjoining structure 
should be nearer than twice the height of the school build- 
ing. 

In laying out a schoolyard, at least thirty square feet 
should be allowed for each pupil. For instance, if a six- 
room building is to be erected to accommodate three hun- 
dred pupils, the playground should contain not less than 
9,000 square feet. In the larger cities it will naturally be 
found difficult to have extensive grounds about the school 
building; but, wherever feasible, plenty of ground for 
play and exercise should be planned for. 

Too often, however, hygienic conditions are ignored in 
the selection of a school lot and more mercenary consid- 
erations are allowed to prevail. Cost becomes a great 
factor in the decision, and often a school is located in one 
particular place because the land is cheap. Or the cen- 
trality of a site may determine the selection, or the dislike 
of property-holders to have a school building too near 
residences, the school being looked upon as a very poor 
neighbor. But the importance of a wise selection of land 
for a school should rise above all other factors in the de- 
cision, and the truth should be borne in mind that no lot 
is too good for school purposes. 



CHAPTER II 
The Construction of School Buildings 

We shall consider the construction of school buildings 
entirely from a hygienic point of view. The general out- 
lines and appearance of the building, and its interior 
adornment, have received exhaustive attention from 
architects; the artistic aspect of the subject we shall leave 
to those better qualified to do it justice. Within the past 
ten years, it is true, following the trend of other profes- 
sions toward specialization, some architects have been 
giving careful study to school construction and have pro- 
duced schools containing in the aggregate more sanitary 
improvements than had been worked out previously in 
as many decades. Experience, however, has shown that 
many architects have not as yet well handled the subject 
of school construction, and that too often such consid- 
erations as proper lighting and ventilation, proper loca- 
tion of cloakrooms and sanitary closets, are neglected. 

The construction of school buildings, indeed, should 
receive as much attention from the sanitary officer as 
from the architect ; and when the two shall work together, 



The Construction of School Buildings. 5 

we may hope to see ideal school buildings. We should 
bear in mind that such buildings would be as varied as 
the demands of different communities. The building 
that would fill the needs of a metropolis would not be 
suitable for a country cross-roads and vice versa. There 
are general rules, however, that apply in all cases. 

The cellar should be so constructed as to be at all 
times dry; the top of the foundation should be at least 
three feet above the ground level, in order that plenty of 
light may be admitted to the basement. The floors 
should be of concrete or asphalt, and the walls of cement. 
The cellar should not be a foul, dark storage room for old 
rubbish, but a clean, ventilated, and well-lighted room 
that could be used in stormy weather with safety, as a 
playground for the children. 

It is not vv^ise to construct high buildings for school 
purposes for two reasons : first, stair-climbing is not a 
healthful exercise, especially for growing girls; and, 
secondly, in case of fire the danger is greater than in a 
low building. Buildings of two stories high should be 
the general rule; they should never be higher than 
three stories. The lowest grades should be assigned the 
rooms nearest the ground floor. In many of the larger 
cities the cost of land is such an important factor and the 
school population so dense that it is necessary to erect 
buildings of a number of stories in height. Of necessity 



6 The Hygiene of the Schoolroom. 

the playground space is very limited, and for this pur- 
pose the roof is finished in such a manner as to afford a 
recreation place for the children. In such cases the sides 
of the roof are of course well protected by a high fence 
or wall to avoid accident during play. In many schools 
much pride is taken in these roof gardens, which are 
decorated with flowers and plants, affording pleasant 
places for the children's recreation. 

The school entrances should be large and sufficient in 
number. The corridors must be roomy, and, with the 
stairs, should be fire-proof, even though the rooms them- 
selves are not so. The stairs should be at least five feet 
wide, built with a landing near the middle of each flight. 
The steps should be of uniform box-like shape and of 
equal width : triangular steps and steps over eight inches 
high are to be avoided. 

The cloakrooms or wardrobes should not be a part of 
the schoolroom. This latter point should receive par- 
ticular attention, as there can be no question that the 
outer garments of the children are a favorite hiding place 
for disease germs. Personal observation has shown that 
in houses where contagious diseases exist, the outer gar- 
ments receive little or no attention, and often form part 
of the covering of the sick one. When the patient re- 
covers, these same garments, so pregnant with dis- 
ease, are taken to the common cloakroom and huddled 




Fig. 1. 

Standard School Wardrobes in a School Hall. 



8 The Hygiene of the Schoolroom. 

together with dozens of others, which thus become a 
most excellent medium for transmission of disease. 

A model cloakroom should be separated from the 
schoolroom and connected with the corridor. It should 
contain individual compartments, or lockers, for each 
pupil's garments, and windows should be so arranged 
that a constant supply of fresh air may circulate freely 
about the clothes and rid them of the disagreeable stifling 
smell that so often clings to them and fills the schoolroom. 
The cloakroom should not be kept warm, as germs thrive 
and multiply much more rapidly in a warm room than in 
a cold one. 

In several schools in England there are drying closets 
attached to the cloakrooms, for use on damp and rainy 
days for drying the wet shoes and outer wraps of the 
pupils. This most excellent arrangement could well be 
imitated in this country. Along this same line, it would 
be of great service, especially in times of epidemics, to 
have a small air-tight closet or room where garments, 
books, and all other articles brought from home to school, 
could be thoroughly fumigated. Successful fumigation 
can easily be done with formaldehyde vapor and with a 
comparatively inexpensive apparatus. 

If at all possible, bathroom accommodations should be 
provided for the scholars. Recently, six new school- 



The Construction of School Buildings. 9 

houses opened in Boston had well appointed bathrooms. 
The teachers reported their use to be advantageous, that 
the daily bath was invigorating as well as cleanly, and 
stimulated the pupils to better work. 

The children coming from the poorer homes formerly 
were denied these advantages, and often their bodies 
emitted odors which, taken in the aggregate in the school- 
room, were decidedly unhealthful and made a room diffi- 
cult to ventilate satisfactorily. The use of the school- 
bath obviated this unpleasant feature. 

The swimming tank is most to be desired, as in addition 
to its sanitary advantages- it is helpful as a means of bene- 
ficial exercise. The matter of expense often stands in the 
way of its adoption, and if its introduction is not feasible 
the ordinary bath tub, or shower bath, is an efficient sub- 
stitute. 

The proper placing of water closets is an ex- 
ceedingly difficult matter, and even experts differ widely 
on this point. Some favor placing the closets in the base- 
ment or elsewhere within the building; while others find 
positive objection to having the closet placed any nearer 
than fifty feet to the main building. Much can be said 
on both sides. If closets are placed in a cold, bleak part 
of the lot, many children will refuse to respond to the call 
of nature, and will suffer the ills attendant on such delay 
— constipation, hemorrhoids, etc. On the other hand. 



lo The Hygiene of the Schooh-oom. 

there is difficulty if the closets are in the building. For 
example : a modern schoolhouse lately examined in a 
New England town was found to have been most care- 
fully planned — well lighted, well ventilated — and a model 
school building, save in one respect. On warm days in 
summer, and in winter when a strong fire was kept in 
the basement, an odor of urine permeated the whole 
building. The boys were undoubtedly careless, and the 
waste pipes failed to carry off the excreta quickly enough. 
The best plan is to have the closets connected with the 
basement and yet not in it, and supplied with their own 
ventilation and light. 

The important desiderata in a plumbing system in 
school buildings are the rapid and thorough removal of 
the waste, and the establishment, by means of proper fix- 
tures, of a complete barrier to the noxious odors and 
gases. Where the system is slow in carrying off the 
waste, decomposition of the sewage takes place and sewer 
gas forms. School children are noticeably careless in 
the use of closets, and for this reason many schools, par- 
ticularly those for children of the younger grades, from 
first to fourth, have a system that performs automatic 
flushing of the closets every five, ten, or fifteen minutes 
during school hours, according as the mechanism is ad- 
justed. 



The Construction of School Buildings. 1 1 

This automatic flushing principle may be applied to the 
individual closets, or to the latrine system, which is a 
large trough-like repository filled with water over which 
a number of seats are placed. The waste products are 
deposited in these troughs and are washed out automat- 
ically every fifteen minutes or half hour, or at the jan- 
itor's convenience. 

The objection to an automatic flushing device of any 
description, is that it is very frequently out of order, and 
that unpleasant odors are about the closet until the flush- 
ing takes place. 

It can be said, without reservation, that the best closet 
for all grades of children is the one that flushes every 
time it is used, either by means of the chain and pull or 
the mechanism that operates when the weight of the 
body is taken from the seat. There are many closets 
that have all the desirable points, but the principal 
trouble seems to be in finding a satisfactory urinal for 
the boys. This should be constructed of slate and should 
be trough-like in shape, with a continuous and strong 
flow of water through it. The floor should be of slate 
for at least six feet from the urinal, and this part requires 
continual flushing and cleansing, as investigation shows 
that often the floor about, rather than the urinal itself, is 
the source of the odor. 

A system that commends itself to some and is in prac- 
tical use in American cities, disposes of the excreta by 



12 The Hygiene of the Schoolroom. 

burning. The waste products are deposited on an iron re- 
ceptacle and at regular intervals a fire is built underneath 
in a grate, tbe flue of which is connected with the chimney. 
The heat rapidly consumes the products, which pass up 
the chimney in smoke and gases. This is not a system to 
be praised and should be thought of only where sewerage 
is impossible. In country towns, of necessity, the closet 
must be the old-fashioned earth closet in a remote part 
of the lot ; and \vath a very little care in covering in fre- 
quently with dry earth or ashes, it serves its purpose ad- 
mirably. The teacher should never be reticent in speak- 
ing of the care of the closets, whether they are in the 
building or apart from it. Pupils should be taught that 
nuisances in such places will not be tolerated, not alone 
from a moral point of view, but from a sanitary one as 
well. 

If possible, there should be in each building a room 
for gymnastic purposes. A favorite place for this with 
many architects is the basement, and if this part of the 
building is properly constructed and is light and dry, it 
will not be an undesirable location. Here regular gym- 
nastic work and exercises under the supervision of the 
physical instructor can be carried out. A classroom with 
its desks and seats provides quarters too cramped for the 
physical instruction work. The best shape for an exer- 



The Construction of School Buildings. 13 

cise room, as for any schoolroom, is an oblong, the longer 
side being that through which the light is admitted. 

Many states have carefully drawn specifications, that 
must be carried out in school construction to guard against 
fire and overcrowding. In Massachusetts, "the law 
requires that a copy of the plans of every public building 
shall be deposited with the inspector of factories and 
public buildings of the district in which such building is 
located before the erection of the building is begun, which 
plans shall also include the system or m.ethod of ventila- 
tion to be provided, together with such portion of the 
specifications as the inspector may require. The plans 
usually required are a plan of each floor, including the 
basement and the attic, if the attic is occupied, and a 
front and a side elevation, and also plans and sectional 
detail drawings of the system of ventilation. Further 
plans may be required by the inspector if deemed by him 
to be necessary. 

"In planning buildings to be used for schoolrooms, or 
places of assemblage above the first story, provision should 
be made for at least two stairways, and such stairways 
should be as far apart as practicable. No such stairway 
should be less than four feet wide in the clear, and wind- 
ing steps should be avoided. The height of rise and 
width of tread of all stairs, measured on the cut of the 



14 The Hygiene of the Schooh-oom. 

stringer, should be given on the plans. No flight of 
stairs should have more than fifteen steps between land- 
ings. The main stairways from places of assemblage 
should have a width of not less than twenty inches for 
every hundred persons accommodated therein. Such 
stairways should be railed on both sides. All outside 
doors to such buildings should open outwardly." 

In O'rder to prevent fire, the Massachusetts building 
law makes further specifications as to the construction 
details of buildings, as follows : 

"All elevator wells and light shafts, unless built of 
brick, must be filled in flush between the wooden studs 
with fire-proof materials, or lined with metal, or plastered 
on metallic lathing, as may be directed by the inspector, 
and all woodwork inside of such wells or shafts be lined 
with tin plate, lock- jointed. Where floor beams rest on 
partition caps or on girders, wall girts, or on wooden 
sills [the space] between such beams from the caps, 
girders, girts or sills, to the lining floor above [must be 
filled in] solid with brick and mortar or other fire-proof 
material. When floor beams in frame buildings rest on 
ledger boards, each floor [must be thoroughly fire- 
stopped] with brick and mortar resting on bridging pieces 
cut in between the studs, or, where practicable, on the 
ends of lining floor. In brick buildings the space be- 



The Construction of School Buildings. 15 

tween the furrings on the outside walls or brick partition 
should be filled flush with mortar for a space of five 
inches in width above and below the floor beams of each 
story. Where basement or other flights of stairs are en- 
closed by partitions of brick or wood, the spaces between 
the studs or wall furrings must be so fire-stopped with 
brick or mortar as effectually to prevent any fire from 
passing up between such studs or furring, back of the 
stair-stringers. The soffits of all such enclosed stairs, 
and also partitions on stairway side, must be plastered on 
metal lathing. Where a building is occupied above the 
first floor for any purpose [insert statement of purposes 
referred to], and the lower story is occupied for stores, 
or other purposes not connected with the upper floors, 
the stairways leading to such upper floors must be en- 
closed with brick walls or with wooden partitions filled 
solid with brick laid in mortar or other fire-proof 
material, and plastered on both sides on metallic lathing, 
and all doors in such partitions lined with tin plate, lock- 
jointed. All long flights of stairs [must] have two 
smoke-tops in each flight, properly constructed. No pipes 
for conveying hot air or steam can under the law be 
placed nearer than one inch to any woodwork unless 
protected to the satisfaction of the inspector by suitable 
guards or casings of incombustible material. No wooden 



i6 The Hygiene of the Schooh-oom. 

flue or air-duct of any description can be used for heat- 
ing or ventilating purposes.' A space of at least one 
inch [must] be left between all woodwork and the chim- 
neys ; also around all hot air, steam and hot water pipes ; 
these spaces around chimneys and pipes, where they pass 
through floors, [must] be stopped with metal or other 
fire-proof material, smoke-tight. Steam and hot water 
pipes [must] ha\e metal sleeves and collars. x'Ml chan- 
nels and pockets for gas, water and soil-pipes [must] 
be made smoke-tight at each floor. The space around 
all metal or brick ventilating ducts must be fire-stopped 
at each floor with m.ital or other fire-proof material, as 
approved by the inspector. All chimneys [must] be plas- 
tered with one good coat of brown mortar, on the outside 
of brickwork, from cellar to roof. The ceiling of fur- 
nace or boiler and indirect radiator rooms must be plas- 
tered on metal lathing. The/e should be not less than 
one foot in height of open air space between the tops of 
furnace or boiler casing and the ceiling. The entire 
cellar ceilings of schoolhouses and other buildings used 
for public purposes should be plastered on metallic lath- 
ing." 



CHAPTER III 

Ventilation 

In spite of the fact that the subject of ventilation has 
received exhaustive treatment from writers on school 
sanitation, that the dangers of ill-ventilated rooms have 
been repeatedly pointed out, and that systems of ventila- 
tion have been elaborated and perfected, there are count- 
less schoolrooms occupied daily in which the air is not 
so pure as in an ordinary stable. Many of these are in 
buildings constructed long ago, when no one thought of 
providing any other means of changing the air in the 
schoolroom than the doors and windows offered. Such 
buildings are hard to ventilate without causing serious 
discomfort to those who are seated near the open door or 
window, and, in consequence, the schoolroom too often 
goes unaired. But not only in old-fashioned schools is 
the supply of fresh air inadequate or neglected : even to- 
day schoolhouses are being built with little or no regard 
to ventilation. 

There can be no excuse, however, for disregarding the 
dangers of having children live in an impure atmosphere : 



1 8 The Hygiene of the Schoolroom. 

sanitary literature teems with warnings. The New York 
Board of Health estimates that forty per cent, of all 
deaths are attributable directly or indirectly to bad air. 
Dr. A. N. Bell, of Brooklyn, N. Y., in a paper read be- 
fore the Public H'^alth Association of Philadelphia, says : 
"The depressed state of the organism under the prevail- 
ing conditions of a badly ventilated schoolroom not only 
predisposes to epidemic diseases, but the liability to and 
the danger of all diseases are intensified ; and vicissi- 
tudes of weather, which under favorable circumstances 
may be encountered with impunity, under these depress- 
ing influences become dangerous perils; and doubtless 
much that is attributed to the season of the year supposed 
to be predisposing to scarlet fever, measles, whooping- 
cough, diphtheria, and some other common affections of 
children, is due to the same cause." 

Dr. James Johnson, in his "Diary of a Philosopher," 
says : "All the deaths resulting from fevers are but as a 
drop in the ocean when compared with the number who 
perish from bad air." Nor can there be any doubt of the 
value of proper ventilation. Prof. S. H. Woodbridge, 
of the Massachusetts Institute of Technology, in his 
notes on "Ventilating and Heating," makes clear the 
effects of the introduction of a system of efficient ventila- 
tion when he tells us that b}^ this means "death rates 



Ventilation. 19 

have been redaced in children's hospitals from fifty to 
five per cent. ; in surgical wards of general hospitals, 
from forty-five to thirteen per cent. ; in army hospitals, 
from twenty-three to six per cent., and in prisons, from 
eighty to eight per cent." ; and Dr. Oliver Wendell 
Holmes, in his "Medical Essays," is responsible for the 
statement that "a simple measure of ventilation pro- 
posed by Dr. John Clark had saved more than sixteen 
thousand children's lives in a single hospital." 

Between good air and bad there is more difference 
than might be thought. Chemically fresh air consists of 

79 per cent, of nitrogen,* 

20.96 per cent of oxygen, 

.03 per cent, of carbon dioxide (carbonic acid gas), 
with traces of ammonia (nitric) acid and watery vapor. 

Expired air contains : 

79.2 per cent, of nitrogen (very little change), 

15.4 per cent, of oxygen (a loss of over five per cent, 

of this life-giving element). 
4.3 per cent, of carbon dioxide (an increase of over 
one hundred fold). 

Carbon dioxide in excess in the air is not poisonous, 
as was formerly believed, although when a great deal of 



* One per cent, of what was considered nitrogen is another elementary gas, argon. 



20 The Hygiene of the Schoolroom. 

this gas is present, as in the air at the bottoms of wells, 
the air is irrespirable. 

But air also contains volatile organic substances, which 
the skin — by a so-called "insensible sweating," not neces- 
sarily accompanying moist perspiration — and the lungs 
give off. These organic exhalations, which can be 
readily detected by the nose when one comes into a close 
room where a number of persons are sitting, are the 
deadly principle in vitiated air. To illustrate the poison- 
ous nature of the exhalations from the body, the follow- 
ing fact is cited : A four-year-old child, because of his 
good health and physique, was selected to represent the 
Infant John the Baptist in an allegorical posing. The 
child was stripped, and, to heighten the effect, his entire 
body was covered with gold bronze. The exhibition 
lasted several hours, but when the fete was over no effort 
was made to remove the coating and the following day 
the child died. The covering applied to the body sealed 
up these organic substances, which were absorbed into the 
system and caused the child's death. And that the sub- 
stances given off by the lungs are actively poisonous has 
been shown by Brown-Sequard. He found, upon taking 
the exhaled vapor, condensing it into liquid form, and 
injecting it into the artery of a rabbit, that death fol- 
lowed in less than a minute. Certainly these same toxic 



Ventilation. 21 

substances in circulation in the air to an abnormal degree 
must act deleteriously. 

Pupils soon show the evil effects of breathing impure 
air. Many tire quickly in school, although they are able 
to work with ease on the same tasks at home. The 
teacher notices that although the children work quickly 
and brightly during the first period of the day, an unde- 
sirable transformation takes place after only a short time 
in the vitiated, unhealthful atmosphere. The child finds 
difficulty in application, is much less able to follow out 
a line of thought, and becomes dull, fretful and irritable. 
And there can be no question that many of the headaches 
attributed both by parents and by physicians to eye-strain 
and too close application to study, are the result of im- 
proper ventilation of our schoolrooms. 

The problem seems simple enough, for there is plenty of 
fresh air in the world. The difficulty is in bringing 
about a continuous and regular exchange of pure for 
foul air in school buildings without causing drafts. 

But before considering the practical means of ventila- 
tion, we should estimate the proper amount of air space 
required. A conservative and yet a safe allowance, sup- 
posing the schoolroom to be twelve feet high, would be 
twenty square feet of floor space for each pupil. Thus a 
room 25 feet x 30 feet, giving an area of 750 square feet, 



22 The Hygiene of the Schoolroom. 

would suffice for 38 pupils. Each pupil would have a 
cubic air space of 237 feet, which is very near the gen- 
erally recognized standard. 

There are two methods of ventilation : the so-called 
natural method, by which fresh air is admitted di- 
rectly to the schoolroom from outside by means of 
windows, doors and other openings ; and the artificial, 
by which a definite amount of air is first warmed, and 
then, by means of special appliances, introduced into the 
room, being finally removed when no longer respirable. 
Two systems of artificial ventilation are in use : the grav- 
ity system, by which the currents of air are kept in 
motion by the difference in the weight of cold and hot 
air; and the fan system, by which the air is circulated 
by means of a forced draft from a rotary fan. As to the 
relative merits of the natural and artificial methods, there 
can be no question — the latter is always to be preferred. 
By either the gravity or the fan system it is easy to 
supply 2,000 cubic feet of air to each child per hour (or, 
as the Massachusetts standard requires, 30 cubic feet per 
pupil per minute) ; with only doors and windows it would 
be impossible to supply this amount without creating 
strong and uncomfortable drafts. 

In 188 1, Mr. Richard Briggs, a civil engineer of 
Bridgeport, Conn., made an elaborate series of experi- 



Ventilation. 23 

merits for the purpose of determining at what position in 
a schoolroom, the inlets and outlets should be placed, in 
order to produce the most thorough change of air in a 
given time. The result of these experiments was the es- 
tablishing of the principle that the warm air should enter 
the room from the inner walls, at a point six or eight 
feet from the floor, and that the foul air should be taken 
out from the bottom of the room on the same side. The 
results obtained from these experiments were published 
in the report of the Connecticut State Board of Health 
for 1881, and the system there recommended was em- 
ployed with great success in the Bridgeport High School, 
which was built the same year. 

The Code of Regulations of the Educational Depart- 
ment in England contains the following rules to be ob- 
served in planning Public Elementary Schools : "Apart 
from windows and doors there should be provisions for 
copious inlet of fresh, also for outlet of foul, air ; the best 
way of providing the latter is to build for each room a 
separate air chimney carried up in the same stack with 
the smoke flues. An outlet should have motive power 
as by heat or exhaust, otherwise it will frequently act as 
a cold inlet. The principal point in all ventilation is to 
prevent stagnant air. Particular expedients are only 
subsidiary to this main direction. Inlets are best placed 



24 The Hygiene of the Schoolroom. 

in corners of rooms furthest from doors and fireplaces 
and should be arranged to discharge upwards into the 
rooms. Inlets should provide a minimum of two and 
one-half square inches per child, and outlets a minimum 
of two inches. All inlets and outlets should be in com- 
munication with the external air. Rooms should, in ad- 
dition, be flushed with fresh air about every two hours. 
A sunny aspect is especially valuable for children and 
important in its effects on ventilation and health." 

The teacher who is fortunate enough to find herself in 
a building equipped with modern ventilating apparatus 
has little to think of on this score beyond familiarizing 
herself with the practical workings of the system ; for 
the janitor may not always be at hand in an emergency, 
and the teacher then needs to know how to operate the 
apparatus herself. In some cases, for example, where 
fault was found with the performance of one or another 
system of warming and ventilating, the trouble was found 
to lie in the ignorance of the teacher, who had closed the 
wrong openings. But properly managed, a good system 
of artificial ventilation will very considerably lighten the 
all too heavy burden of the teacher's responsibilities. 

If artificial ventilation is not or cannot be installed, 
however, there are improvements that may be made upon 
the old-fashioned practice of opening wide the doors 



Ventilation. 25 

and windows. When windows have to be used without 
any fixtures for interrupting the direct flow of the outside 
air, much less discomfort to the pupil will result if they 
are opened from the top. But it is wrong to expect proper 
ventilation in a crowded room from doors and windows 
alone. Accessory means can be easily established, as, for 
instance, by milking several openings for the exit of air 
around the top of the room, and others for the entrance 
of air at the bottom. These openings should be provided 
with registers that can be opened and closed at will. If it 
is necessary to use the windows, it is desirable to employ 
some form of the numerous window ventilators in use. 
Some are merely plain strips of board fitted underneath 
the lower sash, allowing the air to enter upwards 
between the sashes. Others are wooden pieces per- 
forated in such a way as to direct the current of entering 
air upwards. Another is a device of glass after the fashion 
of a Venetian blind. An excellent adjunct appliance, 
efficient in its place, but hardly large enough to supply all 
the air required in a schoolroom, is a ventilator made of 
glass enclosed in a wood or metal frame, fitting any 
ordinary window anc placed in adjustable brackets at an 
angle of from five to twenty degrees. It can be readily 
adjusted parallel with the window, and can be attached 
or removed without causing any defacement to window 



26 The Hygiene of the Schooh-oom. 

sash or frame. By its means, the fresh incoming air is 
deflected towards the centre of the ceihng, where it meets 
the warmer air, with which it becomes thoroughly mixed. 
In this way a good, free circulation is produced without 
subjecting persons in the room to drafts. 




FIG. 2. 

There are numerous tests for determining the relative 
amount of impurities in the air, but as all are very 
difficult to perform with the material at hand in an 
ordinary schoolroom, they are left for text-books on the 
subject of ventilation.* The teacher will seldom need to 
use anything but her olfactory nerves to determine that 



* In this country Mr. Gilbert B. Morrison has a very carefully prepared and valuable 
work on this subject. 



Ventilation. 27 

the ventilation is bad. Tlie odor from the impurities of 
the air will often be increased by the odor of fetid dis- 
charges from the ear, of decaying teeth, and of sweaty 
feet ; and the teacher should have no hesitation in search- 
ing out the source of such annoyances, and seeing that 
they are remedied as soon as possible. In all these cases, 
with the possible exception of prolonged discharges from 
the ear, cleanliness is all that is required. An unpleasant 
odor from a chronic ear trouble should be a sufficient 
cause for the excusing of a child from school. The air 
must be kept pure and sweet at all costs, and the teacher, 
in addition to seeing that the artificial ventilation works 
as it ought, should seize every opportunity, as at recess 
and lunch hour, for thoroughly renewing the air by 
opening doors and windows. 

At this point it would be well to insist that the abolition 
of the old-time ten or fifteen minute recess was a serious 
error. It offered an excellent opportunity to air all the 
rooms thoroughly and afforded a breathing spell for the 
pupils. There was also time to give the tired brain a 
rest, to ease the eye strain, and to relax the wearied and 
cramped muscles. But within the past few years the 
recess in many schools has been abolished as being old- 
fashioned and exceedingly difficult to carry out, because 
it interfered with school order. The omission of the 



28 The Hygiene of the Schoolroom. 

recess shortened the day's work of the teacher, it is true, 
but it took from the pupil a very refreshing period. The 
scliool hours should be interrupted during both sessions 
for fifteen-minute recesses, or when there is but one ses- 
sion, there should be a recess of no less than thirty 
minutes. In Germany there is a legal requirement de- 
manding forty minutes intermission, exclusive of gym- 
nastics, for every five hours of school work. 

Governor Peck, of Wisconsin, once wrote an article on 
the abolition of the recess in his own characteristic man- 
ner. He says : 

"Sometimes it looks as though the school officials were 
overdoing the thing in trying to make the schools of the 
present day as different as possible from the old schools, 
where the fathers and the grandfathers got their educa- 
tion. The last 'improvement' that is suggested by school 
boards in some places is to do away with the recess in 
the middle of the forenoon and the middle of the after- 
noon, thus compelling the scholars to stay in the heated 
schoolroom from 9 o'clock in the morning until noon, 
and all the afternoon without a minute of rest. If the 
abolition of the recess does not raise up a race of people 
with nervous headaches it will be a miracle. The old 
recess ! Good gracious ! it was the recess that kept the 
boys and the girls from dying in their tracks. 



Ventilation. 29 

"The recess in school is Hke the sherbet served in the 
middle of a banquet ; it aids the digestion like the blanched 
almonds and the celery and the olives. If the banqueter 
sat and ate of the solids all an evening, and never had the 
rest that comes with the et ceteras, he would die of 
apoplexy before the speaking began. If the scholar 
studies all the time until his head whirls his brain will 
become clogged. When you stop the recess you might 
as well seal up the brain and put it in a bottle of alcohol. 
The boy and the girl have got to have a time to cut the 
string that holds the cork down, and let the wolf howl." 



CHAPTER TV 
Heating 

The temperature commonl}' accepted as proper for a 
schoolroom is 68°!"", and should not be allowed to rise 
over 70°F. Two thermometers should be placed in the 
extreme corners, as the temperature at the forward part 
of the roon., if heated by a stove, or at the registers or 
radiators, will often be above the required point, while 
that of the distant parts of the room is considerably below. 
The temperature should not vary more than three degrees 
in any part of the room. 

Residences, places of business, factories and school- 
rooms are ordinarily kept too warm, often at 80 °F; and 
children who are accustomed at home to a temperature of 
80° F will find discomfort in sitting in the schoolroom at 
68 °F. But constant living in such an overheated atmos- 
phere renders one unable to stand any exposure without 
contracting colds and catarrhal afifections. It has far 
more to do with the great increase in New England of 
such affections than has the much-blamed changeable 
climate Indeed, many hygienists of repute, principally 



Heating. 31 

Europeans, advocate a much lower average heat in the 
schooh'oom than that here suggested, some recommending 
a temperature ol 61° F, and others a temperature even as 
low as 50° F. In America conditions are different, 
and it would not be wise to keep the minimum tem- 
perature under 68° F. One cannot suffer from cold in a 
room at 68° F; yet temperature taken in over seventy 
schoolrooms during the winter months averaged 78° F, 
ranging from 65 F to 85 °F in several rooms. In some 
instances, when too great a degree of heat was found, the 
teachers confessed to liking a very warm room. However, 
personal preferences should be dropped in the interest of 
the school as a whole ; and this interest, we repeat, is best 
served by maintaining a temperature which does not vary 
miore than two degrees from the normal point of 68° F. 

Every school should have its rules regulating the tem- 
peratures of the room in cold weather. If, at the opening 
of school work, the thermometer does not register 60° F, 
the school should be dismissed. If the thermometer is 
60° F or thereabouts, with a probable rising temperature, 
the pupils may be kept without danger. The first part of 
the day's work could be advisedly given to physical exer- 
cises. 

The methods of supplying heat are two, direct and in- 
direct. By the direct system the heat-supplying force is 



32 The Hygiene of the Schoolroom. 

contained in the room itself — a stove, an open fireplace, or 
the radiators of a steam or hot water plant. When a 
stove is used, great care devolves upon the teacher to see 
that no gases are given ofif and that a steady, constant 
heat is furnished, not too intense for those nearest the 
stove. For their protection, it is a good plan to use fire 
screens. In a small building, the open fireplace can be 
advantageously used, since it also serves as an excellent 
means of ventilation. The principal objection to the 
open fireplace is the great waste of heat in the chimney. 
The indirect system consists in warming fresh air out- 
side the room and introducing into the room the air so 
warmed. At present three methods are in general use 
— steam, hot water, and warm air furnaces. Each of 
these methods has many advocates and is vigorously up- 
held as the best. One or another of the indirect systems 
should always be used when possible, as a more equable 
temperature can be kept and results in less distraction to 
pupil and teacher. In a steam plant, the fire heats the 
iron, the iron the water ; steam is generated and is con- 
ducted from the boiler to the heating chamber, in which 
it heats iron again, and the iron then warms the air for 
distribution. The action of a hot water system is sim- 
ilar, except that steam is not generated, and that the water 
is conducted to the heating chamber at a lower tern- 



Heating. 33 

perature, necessitating a much greater radiating surface 
to warm the same amount of air. In the warm air fur- 
nace the fire heats the iron, and the iron warms the air, 
which then passes directly to the point of distribution. 

The choice of a system of indirect heating will vary 
with the size of the building. A two, four or six room 
building can be heated very readily with a hot air appar- 
atus. A building with more rooms requires a steam or 
hot water heating plant or a combination of hot air and 
steam. 

An important point favoring the hot air furnace, 
where available, is the simplicity of its operation. The 
ordinary janitor for a school building is too often selected 
because of his inability to perform any other work in the 
community. Instead, one who has charge of a heating 
apparatus that might by neglect become a source of dan- 
ger, should be a carefully selected man, fully equipped 



Note. The manner in which the children are fed and clothed has a great deal to do 
with their power to withstand cold. Examinations made during the winter months 
showed that a number of pupils were very scantily clothed. Some had no undervests 
and the other garments were of the flimsiest nature. The teacher should, of right, 
investigate such matters as these, and if, as is often the case, the parents are unable to 
remedy the matter, it should be called to the attention of the superintendent to report 
to the poor commissions. Badly-worn shoes and wet feet should be looked after and 
no pupil should be seated at the daily work who has wet feet. Some means of drying 
the shoes and stockings should be devised, as there is nothing more harmful than sitting 
for hours with damp and wet feet. 



34 The Hygiene of the Schoolroom. 

for all the branches of his work, and invariably sober and 
industrious. 

The following requirements in regard to heating (and 
ventilating) apparatus are enforced by the state of Massa- 
chusetts : 

1. That tlie apparatus shall, with' proper management, 
heat all the rooms, including the corridors, to 70° F in 
any weather. 

2. That, with the rooms at 70° and a difference of 
not less than 40° between the temperature of the outside 
air and that of the air entering the room at the warm- 
air inlet, the apparatus shall supply at least thirty cubic 
feet of air per minute for each scholar accommodated in 
the rooms. 

3. That the supply of air shall so circulate in the 
rooms that no uncomfortable draft shall be felt, and that 
the difference in temperature between any two points on 
the breathing plane in the occupied portion of a room 
shall not exceed 3°. 

4. That vitir.ted air in amount equal to the supply 
from the inlets shall be removed through the ventiducts. 

5. That the sanitary appliances shall be so ventilated 
that no odors therefrom shall be perceived in any por- 
tion of the building. 



CHAPTER V 
School Furniture 

The average child is employed at school work during 
the years from five to fifteen. This particular period is 
the growing, or formative, age of the child. Many of 
the bones by the fifth year are in a very imperfect state 
of development; a considerable portion of each bone is 
still composed of cartilage, which is very easily moulded 
into or out of shape. In succeeding years the bone more 
and more displaces the cartilage, and not until about the 
age of puberty are the long bones and spinal column 
fully matured. Habit during this formative period will 
yield permanent after-effects of either good or evil, as the 
case may be. 

At this time in life children should be taught to stand 
correctly, to walk correctly, and to sit correctly. In 
standing, the shoulders should be thrown back, the chest 
extended, and the head held erect. The heels should be 
together, the toes extended, and the weight evenly dis- 
tributed upon both legs. In walking, the same correct 
posture should be maintained and an effort made to take 




FIG. 3. 



Illustrates a desk too high for the child, causing elevation of the right 
shoulder in writing and a corresponding curve in the spinal column. 



School Furniture. 37 

even, graceful steps with feet well lifted from the ground 
at each step. 

Both standing and walking can be improved at will ; 
but in seating the children a more difficult problem is en- 
countered. Certainly every one must regard the old- 
fashioned bench, or box form, as a hopeless anachronism ; 
yet doubtless very many children to-day suffer from 
the effects of badly made school furniture — as unsuitable, 
in fact, as that which Charles Lamb describes : 

"Oh ! how I remember our legs wedged into tliose un- 
comfortable sloping desks, where we sat elbowing each 
other, and the injunctions to attain a free hand, unat- 
tainable in that position." 

The seat and desk for each pupil should be most care- 
fully looked after; for medical works are filled with 
words of warning against the use of ill-fitting school fur- 
niture. Many eminent physicians, especially in Europe, 
have given a great deal of study to this very evil, and, 
as a result, have devised various desks and seats to rem- 
edy the defect. According to Dr. Earner's theory, a pu- 
pil while sitting at a desk improperly constructed invol- 
untarily assumes an injurious position. Often the injury 
is caused, during writing and reading exercises, by the 
pupil's turning his head to the front or left while writing, 
and downwards while reading. The bad results that 




FIG. 4. 

Illustrates too great space between the seat and desk, causing pupil to 
stoop too much, inducing round shoulders. 



School Furniture. 39 

may follow from putting children into seats too high and 
large for some, too small and low for others, are near- 
sightedness,* round shoulders, curvature of the spine, 
difficulty of respiration, distortion of the upper part of 
the body, pains and tingling sensations in the feet. 

The danger from bad positions lies in the fact that 
they remove the centre of gravity of the body or of the 
head from its natural point of support. It is essential 
that the centre of gravity of the body be supported by the 
seat just as it is supported by one's feet while standing. 
This is impossible, however, if cramped or stooping posi- 
tions are taken, as that throws the centre of gravity for- 
ward to the right or left, as the case may be. When a 
person sits erect, this centre of gravity is directly over 
the spinal column, and the head itself is supported and 
balanced by the muscles of the neck. But all this is 
changed by any forward movement, for then the centre 
of gravity of the head moves forward out of its natural 
position, and the head must therefore be supported and 
balanced by the help of a strong tension of the muscles of 
the back of the neck. When the muscles which support 
the head become tired, the head droops at once into an 
unnatural position and the shoulders become stooped. 



* The normal reading distance, measured from the pupil's eye to the book, should be 
fourteen inches ; children who show any considerable variation from the normal should 
be looked upon as near-sighted or far-sighted. 




FIG. 5. 



Illustrates a very common fault in school furniture, a too high seat. The 
child is unable to rest the limbs on the floor and leans over on the desk 
for support. 



School Furniture. 41 

The more common defects of school furniture, as 
enumerated by Dr. D. F. Lincoln, of Boston, are : 

"First, the desk may be too high for the child's sitting 
height, causing an excessive elevation of the shoulder 
of the hand which the child will write v/ith, usually the 
right. In attempting to get the elbow on the high desk, 
the shoulder is elevated, the corresponding one lowered, 
and the spinal column tilted. 

"Second, the desk may be too low, causing the child to 
stoop forvv^ard. This causes the neck to flex upon the 
body, producing interference of circulation from the 
head, congestion resulting, which interferes with the 
eyes. This same fault causes round shoulders from the 
continued stooping to be sufficiently near the work. 

"Third, desk too far from seat, with stoop of the body, 
injuring the eyes. Danger here is in injuring the health 
by compression of the abdomen and chest, dyspepsia, 
small chests and round shoulders. 



Note. Most authorities concede that better positions in the seat are maintained by 
the child in writing with the vertical method than with the old slant method. It is ad- 
visable that the desk lid should be movable as a shorter distance is needed in writing 
than in reading. 

Note. In speaking of school furniture we call the vertical space between the rear 
edge of the pupil's desk and the plane of the seat the "difference." It can be ascer- 
tained by measuring the distance from the seat bones to the elbow when the arm hangs 
down " Distance " is the special term for the horizontal space between the rear edge 
of the desk and front edge of the seat. 




FIG. 6. 



Illustrates a too small " distance " between the seat and desk, causing 
pressure on chest and stomach. 



School Furniture. 43 

"Fourth, flat desk lid, interfering with freedom of 
writing, disadvantageous as respects receiving the Hght 
and compelHng the child to hold up his book in order to 
see. 

"Fifth, seats too high, so that the feet are not supported 
and the legs grow weary. 

"Sixth, insufficient support for the back, causing fatigue 
and improper attitudes and consequent tendency for the 
spine to yield and take a side curve. 

"Seventh, seat not hollowed suitably, causing pain and 
restlessness. 

"Eighth, a well-proportioned desk and seat, but not 
adapted to size of the child using it." 

In a proper seat the child should be able to sit back 
firmly and have both heel and sole touch the floor fairly, 
with the upper and lower leg forming a perfect right 
angle. Foot-rests are particularly tiresome, as they limit 
too narrowly the motion of the child's feet. The back- 
rest should follow in shape the normal curves of the 
spine and should not reach higher than the lower border 
of the shoulder blades, for otherwise the free movements 
of the arms and shoulders are interfered with. 

School furniture of the stationary kind requires the use 
of different sizes of seats and desks to fit the needs of the 
pupils; furniture, on the other hand, so devised that the 




Fig. 7. 

Illustrates a desk and chair too small for pupil's size, causing cramping 
of the lower limbs. 



School Furniture. 45 

seat and desk can be adjvisted to proper size by raising 
and lowering, is now in very general use, and no other 
kind considered. Physicians, ocuHsts, and educators 
everywhere are united in advocating the use of 
adjustable school desks, and surely some importance 
should be attached to their advice, for their daily experi- 
ence brings additional proof of the serious damage re- 
sulting from fitting the child to the seat rather than 
fitting the seat to the child. Dr. Charles L. Scudder, of 
Boston, an earnest student of school furniture, has made 
extensive examinations in the schoolroom, disclosing the 
following facts : 

"Examination made of thirty-seven schoolrooms in 
Boston showed that only one-third were provided witli 
two sizes of desks and seats. In every instance where 
these two sizes were found, there were only a few of the 
second size, and the difference in these from the others 
was scarcely noticeable. It was found that the rule in 
grammar schools was that the seats were of the same size 
throughout the room and that these were placed at desks 
of uniform height. In the matter of age there were 
differences in schoolrooms of from five to nine years. 
Children with seven years difference in age and with 
fifty-seven centimeters difference in height were found 
seated at the same size desks in seats of equal height, but 



4.6 The Hygiene of the Schoolroom. 

The results of such a condition are faulty and dangerous 
positions assumed in sitting and later in standing, and 
these positions unavoidably lead to serious deviations of 
the spine and to an unnatural elevation of the shoulders. 
These produce, with growing children, serious deform- 
ities. They are caused by desks which are too high or 
too low for the pupil's lower leg, by seats too long or too 
short for the thigh, by distance from the desk to the seat 
either too short or too long. It was clearly brought out 
in this investigation that the method of seating in school- 
houses was defective in the extreme, leading to permanent 
deformity in the spine and distorted eyesight. In this 
respect, Boston is far behind other cities, such as Worces- 
ter, Springfield and Lowell. In these places it has been 
recognized that the only remedy for the evil lies in pro- 
viding adjustable desks, so that the pupil may be per- 
manently fitted wath the desk he occupies, and nothing 
but adjustable desks are purchased. The director of 
physical training in the public schools at Woonsocket, 
R. I., in 1 90 1, after examining about four thousand 
pupils, reported that over two hundred children could not 
touch their feet to the floor in any seat in their respective 
rooms, and that twenty-six children were too large for 
the seats given them. In six rooms, over fifty per cent, 
could not touch the heels to the floor, the largest num- 



48 The Hygiene of the Schoolroom. 

ber of misfits in any one room being thirty-two out of 
forty-six. Blocks were provided in many cases, but the 
fact remains that much of the school furniture is too large 
for the children who attend school in this city." 

Before the National Academy of Medicine, Dr. John 
Jay Moore read a paper on school furniture in which he 
said: "I will endeavor to explain what has been the cus- 
tom in seating our schools, and then you can readily see 
where the difificulty exists. When we have had a new 
building to seat, the grade of the school and the num- 
ber of pupils to be accommodated in each room is ascer- 
tained by the superintendent, and the approximate ages 
of the children who will attend the school of a given 
grade. From this the size of the seats and desks to be 
used are obtained, regardless of the heights of the pupils 
in the dififerent rooms. In the rooms in the modern 
buildings there are placed fifty-six seats expected to 
accommodate pupils from the age of eleven to fifteen, 
and in different rooms ranging in height from five feet 
eight inches to four feet four inches, with all the inter- 
mediate sizes. These fifty-six pupils, if the seats are all 
occupied, are expected to be perfectly seated with but 
two or three different sizes of seats. We find in one seat 
a pupil with the chin but little above the desk ; in another 
we find the desk so low that the pupil, when sitting in 



School Furniture. 49 

ail upright position, can not see his work, thus being 
compelled to assume a position which will produce a 
crooked back or ruin his eye-sight. Still we find another 
little fellow who cannot touch the floor with his feet, thus 
losing the support to the spine which becomes so neces- 
sary to the welfare of the child at this age. 

"For the lower extremities at nine years, those of the 
girls are longer, at eleven shorter, and from twelve to 
fourteen again longer. At fifteen the lower extremities 
of the girl almost cease growing, while those of the boy 
increase by four inches between the ages of fourteen and 
nineteen. The methods by which the seat-makers arrive 
at the sizes necessary leave all the scientific points out of 
their calculations, and give us an arbitrary size for all 
pupils of a given age and grade. The bad efifects that 
result from the disproportion of the seat to the child are 
bad positions assumed in sitting, and a child that is com- 
pelled or allowed to assume faulty positions while sitting 
will assume faulty attitudes in standing. The effect of as- 
suming malpositions repeatedly tends to make permanent 
and to exaggerate these malpositions, which amount in 
time to permanent deformity. 

"In school children we have to deal with developing 
spines, which are soft and capable of being molded. It 
has been demonstrated that as long as the weight of the 



50 The Hygiene of the Schoolroom. 

shoulders and head falls on the spine symmetrically only 
a posterior bending will appear. The moment this sym- 
metrical impression is changed there is a tendency for the 
bones and ligaments to become molded and to grow into 
deformed shapes. The fact of the pupils being improperly 
seated causes in many cases lateral curvature. The chil- 
dren in trying to get into comfortable positions throw the 
spine out of plumb, thus predisposing the spine to all 
forms of curvature. 

"Time will not permit me to go into all the details of 
the positions which produce the stooped and round 
shoiulders, as well as those that affect the eyesight. The 
important question now is, TIow can this matter be rem- 
edied?' Beyond a question, the adjustable school desk 
is the only way out of the difficulty." 

But the mere installation of adjustable furniture in a 
schoolroom means nothing of itself; indeed, many cases 
of pupils poorly fatted with seats and desks are found 
where rooms are thus furnished. Every pupil must have 
the desk and chair adjusted to him carefully and changed 
twice a year to allow for growth. In consequence, many 
teachers object to adjustable furniture because of the 
trouble it causes, and also because of the unsightliness of 
the varied heights of desks and seats in the same school- 
room. But these are trivial objections and far out- 
weighed by the great advantages to the child's proper 



School Furniture. 51 

growth. At the present date school authorities who use 
stationary furniture are certainly blamable ; but far more 
to blame are the authorities who install adjustable furni- 
ture and then neglect its proper adjustment to the chil- 
dren. 

There are over one hundred and fifty different makes 
of school desks and seats, varying from the simple, un- 
adorned bench and box-like desk to some exceedingly com- 
plex and cumbersome foreign contrivances. The ideal 
chair and desk should be adjustable and easy of manipu- 
lation. Fig. 9 represents a model chair and desk prop- 
erly regulated to seat its occupant. 

The distance is the space that would be found between 
a vertical line dropped from the rear edge of the desk to 
the floor (A-B), and the fron^ edge of the seat at D, 
which in Fig. 9 is the space between C and D. 

This distance should be a minus quantity when the pu- 
pil is reading or writing. 

The difference is the vertical distance measured from 
the rear edge of the pupil's desk and the upper surface 
of the seat (Line A-C). The proper length of this differ- 
ence should be equal to the space between the pupil's el- 
bow and the seat bones taken in a sitting posture. When 
the pupil is too far away from the desk, he either bends 
forward into an unnatural position or slides too far for- 
ward on his seat and occupies an unsteady position. 




FIG. 9. 

Chmr and desk illustrating proper seating of pupil. 



School Furniture. 53 

The difference between the height of the seat and desk 
should not be such that the shoulders are painfully 
screwed up in writing, nor on the other hand should the 
pupil be obliged to lean forward to write or read. It is 
recommended by Robson., an English authority, that the 
difference should equal the length of forearm or about 
one-sixth the height of the pupil, in which case it will be 
found that the under part of the forearm will rest com- 
fortably on the desk top. The height of the seat should 
correspond to the length of the pupil's leg from the sole 
of the foot to the knee. 

The seat of the chair should be slightly hollowed out 
to fit the body anatomically and should not be so wide 
as to cause pressure against the legs when they are in the 
flexed position. The back support of the chair should 
meet the child's body just below the prominent portion 
of the shoulder blades. 

A small proportion of pupils who are either abnor- 
mally stout or thin, makes it desirable to have in each 
room a few seats that may be adjusted horizontally, 
bringing the pupil nearer to or farther from the desk as 
may be desired. The desk should be raised high enough 
to relieve any possible pressure on the thighs and to allow 
the outstretched forearm to rest comfortably on its sur- 
face without any effort in bending forward. The chair 
and desk to insure a child's use of them for any length 



54 The Hygiene of the Schoolroom. 

of time without growing restless, must support the body 
comfortably and without any sense of constriction. 

Especial care should be given to crippled children who 
are obliged to attend school. Those suffering with hip 
disease, or knee disease, where the joints are diseased 
and immovable, should be given a seat wil;!! desk placed 
eight or ten inches farther away than ordinarily in order 
to allow a greater range of motion. If one of the lower 
limbs be shortened by disease, a small hassock or block 
should be supplied on that side upon which to rest the 
shortened member. 

To cases of curvature of the spine, which are often met 
with in school life, it will be more difficult to give relief m 
seating. The most that can be utilized is a pad or pillow 
of some nature to rest the back. 

Children with such afflictions should be allowed more 
than ordinary privileges in moving about the room and 
should not take part rn the calisthenics, unless the exer- 
cise be especially prescribed by a physician or a physical 
instructor. 

A number of excellent makes of adjustable furniture 
combine simplicity and real merit. A measuring gauge 
with full instructions is usually supplied and the measur- 
ing may be done by the teacher and the changing of 
the seats by the janitor, according to the data sup- 
plied to him. So rapidly do some pupils grow that every 



School Furniture. 55 

teacher should know of the importance of properly fitting 
school furniture, and can easily see that each child is 
comfortably seated. Changes may be necessary with the 
same pupil during the school year. The following table, 
carefully compiled by Dr. Bowditch, of Boston, Mass., 
will give an idea of the pupil's growth during school life, 
and wi'll readily illustrate how a desk at the beginning of 
a school year might be correct and yet at the close of the 
same year be disproportionate. 



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CHAPTER VI 
Light 

In planning the location of a school building, great care 
should be taken to see that it will be well favored by 
sunlight. Sites in hollows and near tall adjoining 
structures should be avoided. In the first place, no ob- 
stacle to the entrance of light shquld exist outside the 
building; and, secondly, a plentiful supply should not be 
hampered by too few or too small windows. A won- 
derful improvement in the lighting of school buildings 
has been made in the last quarter century. A number of 
schoolhouses, particularly the older ones, were founa very 
deficient in light, due to the small, low windows. Fig. 
10 is a type showing how little attention the wmdows re- 
ceived in the construction of a school building twenty- 
five years ago ; and Fig. 1 1 is a strong contrast, giving an 
idea of a modern school building plentifully supplied with 
windows. 

The best light will be had where the longer axis of the 
building runs east and west and the windows are on the 
north and south sides only ; but where a building contains 



Light. 59 

four or more rooms on each floor, it will be more difficult 
to arrange for a fair distribution of light. In such cases, the 
corners of the building should face toward the cardinal 
points of the compass, enabling the sunlight to enter every 
room every day of the year. Aside from its advantages as 
regards light, a building so placed as to get a good sun 
exposure will be more easily heated and more healthful. 
For the best and most equal distribution of light, the 
schoolroom should be long and narrow, requiring win- 
dows on but one side. The desks should be so placed that 
the light will not shine in the pupil's eyes, but come from 
the left and rear. The light from the left is best, because 
it falls without shadows upon the desk. As the great 
majority of pupils are right-handed, they would be 
annoyed, when writing, by the shadows that the light, 
coming from the right, would cast upon their work. Cross 
lights from both right and left are also objectionable. 
Light from the front is sure to dazzle the children's eyes. 
If the light from the rear predominates, the pupil's head 
casts a shadow, and there is the added objection of the 
teacher's inconvenience in facing light from the rear. If 
the light from this source, however, be indispensable, the 
teacher can change the location of the desk to the rear oi 
the room, where the same oversight of the pupils is pos- 
sible. Many teachers prefer their desks in this 




Fig. 11. 

Showing modem school building plentifully supplied with windows. 



Light. 6 1 

position. But for teacher and pupils alike, light from 
the left side is desirable. 

The windows should be high, reaching almost to the 
ceiling, and should cover an area equal to at least one- 
fifth of the floor space of the room. For instance, to de- 
termine whether sufficient light can be admitted : first, 
find the floor space by multiplying the length by the 
breadth of the room; then multiply the height of each 
window by the width, and this product by the number of 
windows. The latter amount should be at least one-fifth 
of the area of the floor. 

Robson (previously quoted) contends that the win- 
dow-sills should be at least five feet above the floor, and 
that the windows should run very high, in order that the 
light may descend on the pupil's work. This, however, 
in the case of an ordinary room of average height (twelve 
or thirteen feet), would entail a sacrifice of at least a 
foot of good lighting space, as there is little danger of 
the light shining upwards into the pupils' eyes if the sill 
of the window is three and one-half or four feet from the 
floor. 

In every part of a well-lighted schoolroom the pupil 
should be able to see to read well, without an extra efifort, 
at the normal reading distance, which is about fourteen 
inches. Artificial illumination should never be considered 



62 The Hygiene of the Schooh-oom. 

in a schoolroom, except in evening schools, where its use 
is imperative. In such cases, the best light, from a 
hygienic point of view, is the incandescent lamp with 
ground glass globe. The use of the photometer, which 
measures the exact amount of light in a given room, 
will show that there are many schools to-day whose light 
needs to be greatly improved. This may be done by en- 
larging the windows both in breadth and length, and also 
by using reflectors and prisms, to be placed where the 
light enters, which greatly increase the amount. 

The most evil effect of insufhcient light is the defective 
eyesight now becoming so common in school children. 
It is not necessarily the continuity and closeness of appli- 
cation, but the bad conditions under which the eye must 
work that are responsible for so much eye-strain. Dr. 
W. A. Mowry cites a case which well proves this par- 
ticular point : 

"A school was built wherein special pains were taken 
with hygienic matters, good air and excellent light were 
abundant. The two hundred and fifty boys were exam- 
ined upon entering, again in two years, and lastly in two 
years more. Almost without exception the eyesight, in 
spite of the constant use, was improved, showing that it 
is possible to obtain the right amount of light and the 
good effects following. The conditions bringing about 



Light. * 63 

such resuUs were as follows : Light admitted from one 
side and that from the left side of the pupils as they were 
seated. Window space equalled ten per cent, of floor 
space. Windows long- and high. Rooms were long and 
not wide, no pupil being seated farther than twenty-seven 
feet from the source of light. No swivelled blinds, ad- 
mitting light through the crevices, but a semi-opaque 
curtain." 

Some schoolrooms have a fair amount of light on dry, 
clear days, and but very little on cloudy days. A teacher 
in such a room is justified in seeing that too close appli- 
cation, as in reading, is not required on dull days, but 
that exercises at the blackboard are substituted. 

Too much light, with its blinding glare, is as harmful 
as too little. When the sun shines directly on the pupils 
and their work, it should be toned down with a sliding 
curtain of a Hght straw color. The best curtain is the 
one that works on a sliding device, enabling it to be ad- 
justed to any part or space of the window. 

The walls of the schoolroom should be of a light green 
tint, as the reflected light would then be most easy upon 
the eyes. 



CHAPTER VII 

The Hygiene of the Eye 

That our power of vision is degenerating cannot be 
gainsaid : defective eyesight is one of the penalties we pay 
for education. Savage nations have especially good sight 
and very little trouble with the eyes. Nations that follow 
agriculture, or whose work is not of a very fine grade, 
or where the education of the young is limited, have far 
better eyesight than highly educated people whose work 
is of a more refined order. Germany is the greatest 
sufferer : one investigator says that sixty-nine per cent, 
of its inhabitants have defective vision. Children in the 
country, where the range of vision is greater than in the 
crowded cities, are not so prone to eye-troubles as city 
children. But though this degeneracy is a condition that 
accompanies advance in civilization, we should not accept 
it as inevitably a result of civilization. We should rather 
let it spur us on to do all in our power to better the con- 
ditions that afifect vision. In this country, owing to t6e 
enormous increase of defective eyesight, the subject is 
forcing itself upon the medical profession and upon the 



The Hygiene of the Eye. 65 

laity as well. It is a well-known fact that this trouble is 
hereditary and also congenital. The scientific researches 
of Dr. Ely, of New York, prove conclusively that in a 
large number of cases children are born far-sighted. 
Formerly it had been held that the only congenital defect 
found in the new-born was near-sightedness ; but Dr. 
Ely had the opportunity of examining the eyes of a 
number of infants, and was surprised to find that a large 
majority came into the world with far-sighted eyes. In 
most cases, the trouble would naturally, in time, grow 
less, if only the eyes were used with great care. Instead, 
we have early and constant application to books in poor 
surroundings, and a consequent increase of the difficulty 
before the tenth year is reached. In Germany, Dr. Con- 
rad, investigating among school children, found that 11 
per cent, were short-sighted at nine years, 55 per cent, 
at eighteen, and 62 per cent, at twenty-one. Dr. Loring, 
an American investigator, found that school life rapidly 
impaired vision, but not to such a startling extent as in 
Germany. According to his figures, at nine years 3.5 per 
cent., at eighteen 20 per cent., and at twenty-one 2^ per 
cent, sufifer from short-sightedness. 

The farther one progresses in the scale of education, 
the greater will be the liability to injury of the eyes. 
This point is well brought out by Dr. Cohn's table : 



66 The Hygiene of the Schoolroom. 

o , 1 Average per cent. Average amount 

of short-sightedness short-sightedness. 

Country 1.4 1/24 

Primary 6.7 1/23 

Intermediate io-3 1/22 

Polytechnic 19.7 1/20 

Latin 26.2 1/19 

Universities 59 • ° i/i 2 

Knowing, then, that many children have weak eyes long 
before they enter the schools, we should make every effort 
to guard the eyesight of pupils and to study the conditions 
and means of its improvement. 

The strangest point brought out by the writer through 
an extensive examination of the eyes of school children, 
and adults as well, was that although the eyes of many 
were seriously affected, the persons were apparently 
ignorant of the fact. The onset was insidious, and little 
notice had been taken until the damage was irreparable. 
Twelve pupils were found who had practically no sight 
in one eye, yet who were all doing the required 
school work. The remaining good eye had been saddled 
with the work of both and was doing it as well as pos- 
sible. It so happened that the trouble with the eye was 
in the retina and the optic nerve ; and as the child did not 



The Hygiene of the Eye. 67 

complain, and there was nothing in the outward appear- 
ance of the eye to draw attention to it, the trouble 
passed unnoticed. A number of teachers frankly ad- 
mitted that they had thought many pupils, who in reality 
were suffering most severely from defective vision, 
merely stupid and inattentive. 

The writer examined the eyes of one thousand school 
children in their respective schoolrooms. The Snellen 
test types were used, and each eye tested separately. The 
pupils were from eight to fifteen years of age, and were 
of all social grades. No difference was noted between 
the aptitude of poorer, ill-nourished children having de- 
fective vision and that of the children of the well-to-do. 
Very slight defects were not noted, but all marked had 
noticeable trouble. 

The results, to say the least, were appalling. Of one 
thousand examined, 334, or 33.4 per cent., were defective. 
One in every three examined was doing work for which 
he was not fitted, was straining his eyes to do that which 
required normal eyes. No allowance was being made in 
any case, as, in the majority of instances, the teacher was 
unaware of the difficulty. The usual symptoms of eye- 
strain, such as headache, restless sleep, loss of appetite, 
twitching of the eye and lid muscles, are not always 
present, and nothing but periodical examinations of the 



68 The Hygiene of the Schoolroom. 

eye will show existing defects. Often, too, many pupils, 
from a natural reticence, will not complain, although 
suffering. 

The following tables show the results in detail: 

ONE THOUSAND CASES EXAMINED. 

Both eyes defective 146 

Left eye only 1 24 

Right eye only 52 

Entire absence of sight in one eye 12 

Number of cases of strabismus, or squint 28 

Those defective using glasses to correct vision 16 

Not using glasses 318 

Granular lids • 4 

Corneal scars 2 

VISION AND HEARING TESTS IN PUBLIC SCHOOLS. 
(gulick and ayres.) 
Place. Date, 

Bayonne, N. J 4,610 353 7.7 

Camden, N. J 1906 10,028 2,757 27.7 

Cleveland 1900 30,045 6,221 20.7 

Cleveland, well-to-do district 1907 668 216 32.4 

Cleveland, congested district 1907 616 437 71.7 

Dunfermline 1907 1,526 255 17.0 

Edinburgh 1904 1,330 574 43.2 

Massachusetts 1907 402,937 99,609 22.3 

Counties of Mass. except Suffolk. .. . 1907 .... ••■■, 19-9 
Suffolk County (Boston, Chelsea, 

Revere, Winthrop) 1907 .... .... 30.7 

Milwaukee 1907 1,960 293 14.9 

Minneapolis 25,696 8,166 30.0 

Minneapolis 1908 710 170 23.9 

New York City 1906 79,065 24,534 31.3 

Pawtucket, R. 1 1901 4,663 517 11. i 

Utica, N. Y 1897 6,113 667 10.9 

Worcester, Mass ii>953 2,281 19.1 



The Hygiene of the Eye. 



69 



It is little less than criminal that conditions are allowed 
to exist resulting in such wholesale havoc with the chil- 
dren's eyes. Our first great duty is a realization of the 
situation, a survey of the probable offending causes, and 
an earnest attempt at their betterment. 

If we could understand the beautiful and delicate 
mechanism of the human eye, we might take greater pains 
to preserve its usefulness. Nature has wisely foreseen 
the delicacy of the eye, the great care required for its 
well-being, and the necessity of guarding it better than 
the organ of any of the other special senses. It is set into 
and protected by the bony orbital cavity. In front it is 
protected by two curtains, the eyelids. 

The eyeball, on account of its almost incompressible 
nature, cannot be drawn into the socket, but simply 



,6cleroflc 
' Choroid 

Jiefina 




FIG. 12. 



70 The Hygiene of the Schoolroom. 

rotates there, being drawn to either side, up- 
wards or downwards, by small muscles attached to the 
contiguous bony structures. When the adjustment of 
the muscles is perfect, a person is able to draw the eye 
to one side, but the corresponding muscle having an equal 
power, the equilibrium of the eyeball is maintained. In 
consequence of children's diseases, sometimes one of 
the small muscles becomes paralyzed. This muscle is no 
longer able to do its allotted work of helping to hold the 
eye in position, and the eyeball is pulled to the opposite 
side by the unaffected muscle. This condition is known 
as strabismus, or squint, and often follows early cases of 
long- or short-sightedness. 

These cases, as soon as noticed by the teacher, should 
be brought to the parents' attention, with a request that 
an attempt be made to remedy the defect. Very good 
results are often secured by the wearing of carefully se- 
lected glasses upon an oculist's advice. Undoubtedly the 
parent will notice the squint as soon as the teacher, but 
the request of the latter to have something done will 
usually produce good results. Sometimes, however, it 
will be difficult to impress an ignorant person with need 
for action in such cases. One mother who was re- 
minded of her duty in a neglected case, thought she would 
be "flying in the face of Providence." She was finally 



The fiygiene of the Eye. 71 

convinced, nevertheless, of her error in the matter, and 
the case was referred to an oculist, with great benefit. 
With some long-standing cases, glasses will not mend 
matters, and an operation will be necessary. This opera- 
tion is simple, however, and usually successful. Indeed 
oculists are compelled to operate in fewer cases of this 
kind each year, as they are now becoming more adept at. 
removing the difificulty without recourse to an operation. 

When an eye turns in or out or away from its fellow, 
the danger is that the power of sight will begin to fail in 
the eye and will continue to fail. Every case of squint 
discovered, then, should be referred to the eye specialist. 

In studying the eye as shown in Fig. 12 from the front 
to the back, we see the cornea, the aqueous humor, the 
pupil, the iris, the crystalline lens, the vitreous humor, and 
the retina. The cornea, perfectly transparent, is the first 
structure through which the light passes. The aqueous 
humor fills the space between the back of the cornea and 
the lens. The iris divides this space into two chambers, 
the anterior and the posterior. The colorless, transparent, 
bi-convex, crystalline lens serves to focus the light enter- 
ing the eye. The vitreous humor is a soft, jelly-like sub- 
stance, clear and transparent. The retina is the innermost 
lining of the eyeball, and is the sensitive area upon which 
the images from external objects are refracted. 



72 The Hygiene of the Schoolroom. 

k A 




FIG. 13. 

SHOWS THE MUSCLES OF THE EYEBALL IN NORMAL POSITION. 

A, A. The parallel optic axes. C, C. The centres of motion of the 
globes. B, B. Axes of rotation of the oblique muscles. D, D. Axes 
oi rotation of the superior and inferior muscles. n, n. External 
straight muscles. /, /. Internal straight muscles. &, o. Superior 
oblique muscles, running through pulleys at D, D. s. Superior straight 
muscle of one eye. This muscle is removed in the other eye to show 
the optic nerve. »/, ni. Attachments of the inferior oblique muscles, 
which cannot be seen in this view from above. The space between 
D, D, is the cavity of the nose. 



If we look at a house a mile distant and then look at 
one of the fingers placed before the eyes, we find it can 
only be done with a distinct sense of muscular effort 
somewhere in the eye. This effort, spoken of as accommo- 
dation, is the same act as is accomplished by the screw in 



The Hygiene of the Eye. 73 




FIG. 14. 




Fig 15. 




FIG. 16. 



74 The Hygiene of the Schoolroom. 

an opera-glass. It is performed by the aid of ciliary mus- 
cles and the suspensory ligament of the lens, which alter 
the convexity of the lens. Emmetropia is a term used to 
designate normal vision as illustrated by Fig. 14, when 
parallel rays entering the eye are focused exactly upon 
the retina. But in some eyes the eyeball is too long, and 
the parallel rays meet in front of the retina, as shown in 
Fig. 15. This condition is known as myopia, or short- 
sightedness. To enable such eyes to see distant objects 
it is necessary to use concave glasses. Or the eyeball 
may be too short ; then the parallel rays come to a focus 
behind the retina, as in Fig. 16. This condition is called 
hypermetropia, or long-sightedness, and for its correction 
convex glasses are needed. In yet other cases, owing to 
the fact that the cornea or the crystalline lens is not true- 
in shape, the rays are not focused at any single point upon 
the retina. This is spoken of as astigmatism, and is 
usually corrected by cylindrical glasses. 

These are the principal defects that are found in chil- 
dren's eyes, and though the teacher is not expected to 
be able to differentiate them, she should make it her duty 
to report all cases to the proper authorities. In cities or 
towns where a medical inspector is employed in the 
schools, a great burden of responsibility is lifted from the 
teacher's shoulders. If there should.be no such officer, 





6o; 



F z : 



4C( 



OE L 



3C 



L P O 



2C 




N 



i£T. 



3 D E 



jET. 



Z T G 



SET. 



i F D Z 



•ET. 



The Hygiene of the Eye. 75 

the teacher can easily learn to discover at least the most 
flagrant cases of defective vision. 

The tA^pe as printed on the plate opposite can be used 
in examining the eyes, or for a small sum the regular 
Sneller test types may be purchased and hung in 
the room. The record should be kept as fol- 
lows : R. V. is the abbreviated form of writing "right 
vision" ; L. V. "left vision." Seat the pupil twenty feet 
from the test types, and, if examining the right eye, place 
a piece of cardboard before the left eye. If the five rows 
of type can be read entire, vision is normal, or 
R. V. =20/20. If, however, only the four upper rows are 
read, and the thirty-feet type are the smallest discernible, 
the vision would be 20/30. If only the upper row can 
be read, the vision would be but 20/60. Proceed in the 
same manner with the left eye, and use the same means of 
recording the degree of vision. For a reading test, the 
normal eye should be able to make out the following dia- 
mond type at a distance of twelve inches : 



The Facdlty of memory, which receives and retains 
ideas and images, and which exhibits them again 
with or without ihe exercise of volition, early be- 
came the subject of philosophical research. There 
are very many curious phenomena connected with 
this power of the mind ; it is sometimes as recreant 
to its trust, when most its service may be required, 
as the veriest bankrupt; at other times, when in a 
fit of strange caprice, it will obtrude upon us in a 
most unwelcome and unceremonious manner, heap- 
ing upon us thoughts and things we would willin^ ly 
bury in oblivion. Yet, after all, memory is indii- 
penaable to moral economy: its aid is as much re- 
quired 'n things mean as in things immense. Without 
this mysterious private secretary, we could not enact 
our several parts on the arena of life ; our boasted 
being would be reduced to a mere vegetable exist- 
ence. Memory is said to be essential to every kind 
of action; timid animals are instigated to avoid 
capture, and to flee from the attacks of the very 



FIG. 17. — 



76 The Hygiene of the Schoolroom. 

In 1895, Dr. Frank Allport, of Chicago, devised a set 
of practical questions for instructing teachers how to ex- 
amine pupils above the first grade for the detection of 
eye and ear defects. These are: i. Does the pupil ha- 
bitually suffer from inflamed lids or eyes? 2. Does the 
pupil fail to read a majority of the letters in the number 
XX (20) line of the Snellen test types, with either eye? 
3. Do the eyes and head habitually grow weary and 
painful after study? 4. Does the pupil appear to be 
"cross-eyed"? 5. Does the pupil complain of earache 
in either ear? 6. Does matter (pus) or a foul odor 
proceed from either ear? 7. Does the pupil fail to hear 
an ordinary voice at twenty feet in a quiet room? Each 
'ear should be tested by having the pupil hold his hand 
over first one ear and then the other. The pupil should 
close his eyes during the test. 8. Is the pupil frequently 
subject to "colds in the head" and discharge from the 
nose and throat? 9. Is the pupil a habitual "mouth 
breather"? 

If an affirmative answer is found to any of these ques- 
tions the pupil is given a printed card of warning to be 
handed to the parent. These cards are non-obligatory 
in their nature. They do not require anything of the 
parent, who is at perfect liberty to take notice of the 
warning card or not, as he sees fit. If the parent neg- 
bcts the warning it is repeated. 



The Hygiene of the Eye. 77 

With children who are not yet famihar with the alpha- 
bet the tests previously given (p. 74) are useless. For 
such Dr. Cohn suggests the use of a line of capital E's, 
the child to determine, at a distance of twenty feet, the 
direction in which the arms of the letter point, whether 
upwards, downwards, to right, or to left. 

m E 3 111 m 

Fig. 18. 

To examine for astigmatism is far more difficult than 
to examine for hypermetropia or myopia. For such an 
examination the horizontal and vertical lines of Fig. 19 
may be used. Test one eye at a time, r.t a distance of 
twenty feet. If astigmatism is present, some of the lines 
will be blurred and run together, while the others will be 
clear and well-defined. 

A peculiar anomaly in some persons — most commonly 
men — is a failure to distinguish colors. This defect, 
known as color-blindness, is theoretically explained as 
being caused by the absence of one or more of the color 
sensations. To detect it, a heap of worsted yarn of all 
tints is taken, and a thread of a particular color, for in- 
stance a red, is selected. The subject is then required to 



78 The Hygiene of the Schooh-oom. 




Fig. 19. 

test for examining the eyes for astigmatism. 

pick out from the heap a11 of the other threads of the 
same color ; if rcd-bHnd, he will choose not only the reds 
but the greens. It is often a matter of consequence to 
discover this peculiarity, especially in railroad men and 



The Hygiene of the Eye. 79 

sailors, since the colors most often mistaken are red and 
green, the important colors in railroad and marine signals. 
The teacher should constantly watch the pupils for in- 
flamed eyes, inflamed eyelids, styes and squints. She 
should pay particular attention to those that hold the read- 
ing book less than twelve inches from the eyes, or at arm's 
length, to those that tilt their heads when reading, those 
that cannot read blackboard writing from their seats, 
those that complain habitually of headache and those 
that fear the light. The parent should be notified of 
the condition of the child's eyes and encouraged to have 
the proper glasses made and worn. Children with defect- 
ive vision should be looked upon as physically below 
the standard and should not be expected to do full work. 

It should be the duty of school authorities to study well 
every condition that would better the pupil's vision. 
The greatest essential is good light : schools with poor 
light show a high percentage of defectiveness, one case, 
where the light was miserable, running as high as fifty- 
nine per cent. The use of slate and pencil is far more 
harmful to the eyes than paper and pencil. The paper on 
which the books are printed should be heavy and without 
gloss. 

The type used, according to Dr. Cohn of Breslau, who 
is an authority on the optical requirements of good printing, 



8o The Hygiene of the Schoolroom. 

should not be less than 1.50 mm. in height and the small 
" n " not less than 1.30 mm. wide. 

For the beginners in reading, the type should be 5 mm. in 
height, and gradually reduced to 2 mm. in height by the time 
the fifth year of school work is completed. The distance 
between letters of the same word should measure .75 mm. 
and between the separate words 2 mm., with 2.5 mm. to 
3 mm. between the lines. 

The eye is much more easily fatigued in reading long lines 
than short ones, and it is recommended that the length of 
lines of the school book approximate 80 to 90 mm. and be 
not longer than 100 mm. 

It is essential that the type employed in books used in 
the first grade be large and distinct, for now for the first 
time the vision of the child is to be confined to a limited 
space. 

We must use two hands to do 
most of these things. 

Fig. 20. 

The second year, the eye having become habituated to the 
books, the type need not be so large. 

It does not hurt the eyes to use them. 



to 



The Hygiene of the Eye. 

Indeed, they learn to see better by bein 
used, if only they are well treated. 

Fig. 21. 

But in no books supplied for the schools should the type be 
less in size than "Small Pica," which is the type employed 
in this book. 

These matters, however, may be all changed to the 
desirable point, and yet many eyes continue to suffer. 
There is a radical fault in the school system, and that is 
in the school programme : It should be changed so that 
the periods of eye-work would be shortened and greater 
time left between. It is a difficult problem, to solve, con- 
sidering the ambition of the child, of the parent, and of 
the school authority, but the time must come for a wide 
departure from the present mode of work. The course 
of study should be less compulsory — rather elective to 
suit each individual case, and the amount of work ex- 
pected from each child should be a matter for the physi- 
cian to determine after a careful consideration of motor 
and mental ability. 

Care should be taken about the "extras" imposed upon 
a child, such as private lessons in music, drawing, and 
fancy needlework, as often such work is especially 
fatiguing to the child's eyes. The home study should be 
entirely omitted where the pupil has weak eyes. 



CHAPTER VIII 
The Hygiene of the Ear 

Next in importance to the eye in the consideration and 
care that it requires is the ear. The percentage of aural 
defectiveness in school children ranges with different ob- 
servers from six to twenty per cent. Careful examination 
of the hearing of a large number of school children in 
Chicago showed that i6 per cent, had perceptible defect 
in one ear, and that 7 per cent, had defects in both ears. 
Children of the age of seven or eight years were more 
prone to show such defects than those of any other age. 
School conditions, however, will not benefit or harm the 
ear in as great a degree as the eye. 

The causes of deafness will be clearer with an under- 
standing of the anatomy of the ear. It consists of three 
portions : the external, the middle, and the internal. The 
external ear comprises, in addition to the part seen on the 
exterior of the head, the passage that leads inward as far 
as the drum-head. The middle portion, or tympanum, 
is a cavi'ty lying beyond the drumhead. From this part 
a small tube leads to the upper portion of the throat, or, 



The Hygiene of the Ear. 



83 



more properly speaking, the pharynx; this is called the 
Eustachian tube. Its object is to equalize the pressure 
of air on each side of the drum, allowing it to move with 
the slightest air vibration. In the tympanum lie three 
small bones, forming a connection between the drum- 
head and the internal ear. The internal ear consists of 
chambers and tubes hollowed out of the temporal bone. 

D 




f 
FIG. 22. 

VIEW OF THE HUMAN EAR. 

A, external auditory meatus ; B, utricle ; C, saccule ; £>, semi-circular 
canal ; £, nerve ; J^, cochlea ; G, Eustachian tube ; //, tympanic 
membrane ; /, cochlea. 

In 1907, of 402,937 children examined in Massa- 
chusetts for defective hearing, 27,387 or 6.3 per cent, 
were found to be suffering from some degree of deaf- 
ness. In New York in 1906, of 79,065 examined, 
1,633 showed defective hearing, 



84 The Hygiene of the Schoolroom. 

Some points should ahvays be borne in mind. Blows 
on the ear are extremely likely, by forcible compression of 
the air in the auditory canal, to rupture the drumhead. 
Even where corporal punishment is tolerated, this should 
not be the method employed. Pulling the ear will some- 
times cause it to ache. At any rate, if a child be slapped 
upon the ear, or be pulled by the ear by a teacher, the 
parent will use that as an attributable cause for any dis- 
turbance that may at any later time arise. Foreign 
bodies in the ear, such as peas, beans, and small pebbles, 
should be let severely alone, as any probing will usually 
push the substance farther into the canal. They can 
safely be removed only by washing out with an ear 
syringe. There is excellent sense in the old adage, 
"Never put anything into your ear smaller than your 
elbow," which is a facetious way of advising putting 
nothing at all into the ear. Teachers should warn pupils 
against the very dangerous practice of introducing pen- 
holders, pencils and pens into their ears. 

A recent invention called the audiometer has been con- 
siderably used in testing hearing and is valuable from its 
simplicity of operation and the exactness of its working. 
It employs an electric current which can be varied at will 
through a fixed scale of intensities, the operation produc- 
ing a series of clicks in a telephone receiver held to the 



The Hygiene of the Ear. 85 

ear. When this instrument is not available, the most 
satisfactory way of determining the extent of a child's 
hearing is by the "whispered number" test : a normal ear 
should hear the whispered voice at twenty feet. Seat 
the pupil twenty feet away, with one ear towards the 
person making the test, and the other ear blocked by the 
hand. Be careful to note that the child is not looking at 
the examiner, as it would be difficult to tell how much 
was understood by the ears, and how much by sight-read- 
ing of the lips. Whisper any number at random and ask 
the child to repeat, giving at least ten numbers. If the 
child is unable to hear, or wrong answers are given, 
advance slowly toward the pupil, repeating the number 
in the same manner. Make careful record of the hearing, 
marking it normal if the whisper is heard at twenty feet, 
one-half if heard at only ten feet, one-quarter if at five 
feet, etc. The test should of choice be conducted quietly 
and away from the remainder of the pupils. Sometimes 
the ticking of a watch is used in place of the voice; but 
the number test is preferable, since many pupils, from a 
desire to be considered "smart," will profess to continue 
to hear the watch long after they are unable to do so. 
The ticking of an ordinary watch should be heard by the 
normal ear, in a quiet room, at a distance of twenty feet. 
The school, as has been remarked, is hardly as account- 



86 The Hygiene of the Schoolroom. 

able for bad hearing as for bad eyesight. Many of the 
ear troubles follow infectious diseases; some result from 
colds, enlarged tonsils, chronic catarrh, and adenoid 
vegetations ; while others are mechanical in their nature 
and are the result of some foreign body in the external 
ear passages, most often a plug of hardened wax. When 
from the latter source, the trouble can easily be remedied 
by a surgeon. Bad hearing from catarrh is an exceed- 
ingly difficult matter to treat, but the only time that any 
prospect of improvement can be held out is during the 
school age, for usually after this stage the case becomes 
incurable. 

Deafness due to enlarged tonsils and adenoid growths 
in the naso-pharynx is greatly improved when an opera- 
tion is performed. When due to the above causes, a 
defect in speech is usual and the child breathes with the 
mouth half-opened. This condition is known as mouth- 
breathing. The child presents a distracted, expressionless 
appearance, is unable to talk well, to hear well, or to study 
well ; unable to talk well, because the enlarged growths 
in the throat act as foreign bodies; unable to hear well, 
because these same growths block up the Eustachian tube, 
spoken of as running from the throat to the ear; and 
unable to study, because the nose and the throat are partly 
occluded, denying a sufficient amount of air to the lungs. 



The Hygiene of the Ear. 87 

and causing the same sleepy, tired feeling that poor ven- 
tilation produces. Adenoids are believed to be very fa- 
vorable soil for the growth of the tubercle bacillus and 
are often starting points of diphtheria and scarlet fever. 

In 1907, in New York city, of 7,608 pupils examined, 
2,159 suffered from enlarged tonsils and 1,248 with 
adenoid growths. 

A child with enlarged tonsils or adenoid growths 
speaks always as one does with a severe cold in the head. 
He says "cobbod" for "common," and "sig" for "sing." 

The photographs Nos. 23 and 24 show a child with the 
typical face of a mouth-breather from adenoids and the 
change in the entire facial appearance when the offend- 
ing growths have been removed. 

It would be valuable for every teacher to have a 
register kept containing data of each pupil's eye and 
ear capacity. With this knowledge at hand, many who 
are considered stupid would be shown to be only unfor- 
tunate, inasmuch as the avenues to their brain are partly 
blockaded ; they need additional aid instead of censure. 
Those whose hearing is defective should be given seats 
within easy range of the teacher's voice, and should at all 
times be subjects for special consideration and regard. 




FIG. 23. 




FIG 24. 



CHAPTER IX 

The Vocal Organs 

The voice is the sound resulting from the passing in 
and out of the air over the vocal cords, two folds of 
memhrane in the larynx, or upper part of the air passage 
hetween the windpipe (trachea) and the hase of the 
tongue. When the cords are relaxed, the air passes be- 
tween them without sound ; but at will the small muscles 
guiding the cords can be set tighter, so that as the air 
passes they vibrate and produce sound. The difference 
in pitch is created by the degree of tension of these cords ; 
when they are loosely set, a low note results ; when 
tighter, a high one. With the assistance of the upper 
part of the throat (the pharynx), the cavity of the mouth, 
the tongue and the lips, these sounds are modified into 
spoken words. 

A good voice and the ability to speak clearly and dis- 
tinctly are of such incomparable value in after life that 
especial effort should be made by teachers in training the 
voice. With the advent of the Kindergarten, where the 
child comes earlier than formerly under school training, 



The Vocal Organs, 



91 



Aiyhnoxd. carl ■ 




Base ^ r«"5'" 

FIG. 25. 

THE LARYNX AND ADJACENT PARTS, SEEN FROM ABOVE. 



and with the knowledge that the teacher should possess 
of the great improvement persistent effort and patience 
will bring about in the speech of children, the coming 
generation should show decidedly less defectiveness of 
this kind. 

The child is able to talk fairly well by the time he 
reaches the school, having begun usually at from twelve 
to twenty months. Any child at two years of age who is 
not able to talk should be a subject for the physician to 
consider. 



92 The Hygiene of the Schoolroom. 

The principal vocal defects noted are stuttering, stam- 
mering, lisping, drawling, hurried speech, thick and in- 
distinct speech. Many of these affections are inherited, 
and usually manifest themselves when the child is from 
three to seven years of age. Careful observers have 
noted that errors of speech are intensified at about the 
ages of second dentition (six to eight years) and of 
puberty (about fourteen years). 

Stuttering and stammering are commonly, but im- 
properly, used as synonymous. Stuttering is defined 
by Dr. H. Gutzman as a spasmodic nervous disorder 
which obstructs the uttering of syllables by spastic con- 
tractions at the stop points for vowels and consonants in 
the articulating tube. The impeded utterance is accom- 
panied by a spasm, usually of the muscles of the face and 
neck, but sometimes involving the muscles of the trunk 
and limbs, and is always further accompanied by great 
nervous embarrassment. The difficulty is encountered 
principally with the explosive consonants b, p, t, g (hard) 
and k; less often with the other sounds. The impediment 
may be complete (as "bb — oy" for "boy"), or incomplete 
("b-b-b— oy"). 

A stammerer finds difficulty in articulating at all, and 
succeeds only after repeated attempts, while the stutterer 
is able to make sounds, but has trouble with syllabic com- 



The Vocal Organs. 93 

binations. Either trouble may be of central origin — that 
is, resulting from some disturbance of the speech center 
in the brain — or of peripheral origin consequent upon 
some defect of the respiratory passages. 

Dr. Hartwell, in examining one hundred and thirty 
thousand school children in Boston, found that one thou- 
sand of this number were stutterers, and that the pro- 
portion of boys to girls suffering was as three to one. 

Professor A. Melville Bell, who long studied this ques- 
tion, wrote as follows : "No part of education is, in gen- 
eral, so lightly esteemed as that of first learning to speak 
and read ; yet, rightly considered, there is none of more 
importance. The first governess, tutor, or schoolmaster 
should be a model of distinctness in his own practice, and 
should be also intimately acquainted with the physiology 
of articulation, that he may, both by wise precept and 
potent example, mold the plastic mouth to grace and give 
easy play to the delicate machinery of speech. With 
proper initiatory training and school surveillance, stam- 
mering and its train of silent errors would be altogether 
unknown." 

Enlarged tonsils, adenoid vegetatisms, harelip, cleft 
palate and short tongue-strings are all exciting causes of 
impeded utterance. Hysteria and imitation are probably 
causes in some cases, and nervousness is certainly a great 



94 The Hygiene of the Schoolroom. 

excitant in all cases. One pupil, it was noticed, could 
read very well when his back was turned on teacher and 
pupils. Dr. Pershing, of Denver, declares that when 
alone or in darkness the stuttering or stammering habit 
disappears entirely, and it is a matter of common observa- 
tion that undue excitement or embarrassment intensifies 
the defect. 

The treatment of such cases must first be referred to the 
physician, to see if the cause be a removable one. Ex- 
perience shows brilliant results from surgical treatment 
where the cause is peripheral ; less satisfactory results are 
observed when the trouble is of central origin. Given 
a pupil with a speech defect, he should become at once 
a subject for special consideration from the teacher, and 
never should his misfortune be paraded before his fellow 
pupils for ridicule. He should not be called upon for 
special exercises, such as declaiming, until he has had 
sufficient training to give him mastery over his voice. 
Let hitn follow this primary rule : in speaking, whenever 
the impediment is encountered, stop immediately, compose 
one's self, begin again, and stop each time trouble is en- 
countered. 

A great deal of training should be given privately, and 
the child encouraged to think that persistent efiforts on his 
part, when alone, in speaking aloud, will greatly benefit 



The Vocal Organs. 95 

him. He should be told of the illustrious example of 
Demosthenes, whose first public speech made him the 
butt of ridicule, on account of his imperfect utterance, 
and who, after months of patient effort, in speaking only 
to the waves on the seashore, mastered the situation and 
became one of the greatest orators the world has ever 
known. 

Sir Morrell Mackenzie, the greatest of authorities on 
the human \oice, emphasizes the point of early training: 
"If there is any doubt as to when it is best to begin the 
training of the singing voice, there can be none as to 
commencing the education of the speaking voice. It can 
hardly be begun too soon ; in this way faults of production 
and articulation can be prevented, or, as it were, 
'strangled in the cradle,' which in after life can only be 
got rid of with infinite trouble and vexation of spirit. 
Too much stress cannot be laid on the importance of sur- 
rounding a child, even before it can speak, with persons 
whose accents and utterance are pure and refined. The 
Greeks, at their period of highest culture, were keenly 
alive to the necessity of this, and would allow no ser- 
vants near their children, but such as spoke correctly." 

This strong advice is in strange contrast with the per- 
nicious habit many parents have of speaking^to their chil- 
dren in. a foolish lingo of "baby talk." 



96 The Hygiene of the Schoolroom. 

Various other faults of speech will entirely yield to 
proper care. Some children have a rapid, jerky way of 
speaking that mumbles many of ths words together; some 
lisp and drawl ; ethers have a thick, indistinct tone. All 
departures of this nature should concern the teacher and 
receive her earnest attention. She should correct the 
child over and over again until the proper sounds are 
produced. There is no S3'stem or method which will 
benefit those troubled with defective speech so much as 
intelligent and persistent efforts on the part of the teacher 
and parent in clear enunciation. The child will ordi- 
narily be shy and sensitive to the ridicule that his speech 
brings upon him, and speak in a low, muttering tone. 
He should receive sympathy and encouragement always, 
and be instructed to produce loud, clear sounds, bringing 
strongly into play the abdominal muscles and diaphragm. 
Owing to individual peculiarities, some children seem in- 
capable of pronouncing such sounds as "r," making it 
"w," but practice will help greatly. 

On the other hand, many speech defects result from 
congenital defects in the lips, the tongue, the soft and the 
hard palate. Hare-lip is a congenital fissure of the lips 
and may extend back through the bony parts of the 
mouth, causing cleft palate. It is a common deformity 
and interferes greatly with proper speech. Such cases 
should be operated on in infancy, long before the patient 



The Vocal Organs. 97 

reaches school age; but even in school, it should be re- 
membered, it is not too late to operate successfully. 
Tongue-tie is an affection where the tongue is bound 
down and cannot be protruded beyond the teeth. It is a 
serious drawback to proper articulation, but is easily and 
simply remedied by dividing the tongue-string. Cleft 
palate is an unnatural, congenital opening in the roof of 
the mouth and may involve the soft palate or extend into 
the hard palate. The severe forms occasion serious dis- 
turbances. In swallowing, the liquids pass through this 
false opening and out through the nose. As the child 
learns to speak, his articulation is faulty and his voice 
very nasal. Early operation is advisable, before school 
age and preferable before the child has learned to talk. 
"When the operation is undertaken late, even if it is suc- 
cessful, the child will have great difficulty in overcoming 
the faulty habits in speaking already acquired. Defec- 
tive and irregular teeth also are an impediment to proper 
enunciation. The teeth of school children often receive 
scanty care, and, as a rule, are in poor condition. Ped- 
ley, of England, examined the teeth of 3,800 school chil- 
dren, and found that 75 per cent, of that number were 
badly affected. The real province of the school author- 
ities in such matters is not great, but much good will 
come from the teacher's suggestions to care for the teeth 
with frequent cleansings with the brush. 



CHAPTER X 
Relation of Contagious Diseases to the School 

Ordinarily the terms "contagious" and "infectious" 
are used synonymously as referring to diseases com- 
municable from one person to another. There is, how- 
ever, a distinction. Contagious diseases are usually 
transmitted by direct contact, while infectious diseases 
are those borne by water, air or food. The distinction is 
a fine one, ar.d for ordinary purposes the term "con- 
tagious" may be used to cover all diseases that are popu- 
larly spoken of as "catching." 

The rules and principles intended for the public 
schools in relation to contagious diseases are just 
as applicable to private, parochial and Sunday 
schools. The Attorney General of the State of New 
York in 1903 rendered an opinion to the effect that 
though the State Health law does not compel 
parochial school authorities to exclude unvaccinated chil- 
dren from attending school, yet the local board of health 
may direct general vaccination, and provide a penalty for 
con-compliance. The opinion, the first one passed upon 



Contagious Diseases. 



99 



this question, was given as a result of the situation at 
Dunkirk, N. Y. 

The principal diseases to be considered are 
measles, smallpox, mumps, diphtheria, scarlet fever, 
whooping-cough, typhoid fever, chicken-pox, erysip- 
elas, influenza, tuberculosis, typhus fever, and con- 
tagious eye and skin diseases. The diseases enumer- 
ated vary greatly in their contagiousness, some being 
especially violent in their ravages, while others are far 
more inert. 

Dr. Louis C. Parkes has arranged a very comprehen- 
sive table of communicable diseases : 



Class A. 
Contagion, usually 
air borne. 



Smallpox. 
Scarlet fever. 
Measles. 

German measles. 
Mumps. 
Chicken Pox. 



Whooping Cough. 
Influenza. 
Typhus. 
Erysipelas. 
Epidemic pneumonia. 



r Yellow fever.* 
Class B. Cholera. 

Contagion, usually -{ Enteric fever. 



air or water borne. 



Dysentery. 
Diarrhoea. 



Diphtheria. 



* Discoveries in igo2, by means of the experiments of Reed, Carroll, Agramonte, 
Guiteras, and others, proved beyond a reasonable doubt that yellow fever is inoculated 
by the sting of mosquitoes. 



lOO The Hygiene of the Schoolroom. 



r Foot and mouth disease. 
Class C. Lepro^5y. Opthalmia. 

Contagion, usually -=j Glanders. 



by inoculation. 



Rabies. 
I Vaccinia. 



Class D. 
Surface lesion neces 
sary for contagion <J 
air borne or direct 
ly by inoculation 



Erysipelas. 
Pyaemia. 



Tetanus. 



Septicaemia. 



Class E. | Tuberculosis. 

Contagion, air borne ^ Cerebro-spinal menin- 
or by inoculation. I gitis. 



Scrofula. 
Lupus. 



When a disease presents itself in a community only in a 
few and widely scattered cases, it is spoken of as being 
"sporadic." When a number of cases of a contagious 
disease are found in a community, it is said to be "epi- 
demic." A disease would be "epidemic" when found in a 
community m the following proportions : 



For a population of 



lOO 5 per hundred. 

500 4 " 

2,000 to 5,000 2214 per thousand. 

6,000 to 10,000 16 " " 

20,000 to 50,000 8 per ten thousand 

50,000 to 100,000 4 " " 

200,000 and over i " " 



Contagious Diseases. 



lOI 



Most of the contagious diseases are caused by germs 
entering the system, multiplying and thriving and by 
their presence causing the particular ailment. The space 
of time elapsing between the entrance cf the infection 
and the manifestation of the disease is known as the 
"period of incubation." It varies as follows : 



Disease. 



Smallpox. 



Chicken-pox. 



Measles. 



German measles. 



Scarlet fever. 



Diphtheria. 



Period of 
Incubation. 



II to 14, usual- 
ly 12 days. 



7 to 14, usually 
12 days. 



ID to 14, usual- 
ly 10 days, 



7 to 15, usually 
14 days. 

I to 7, usually 
3 to 4 days. 



: to ID, usually 
2 to 3 days. 



Appearance of 
Eruptions. 



Second or third 
day on face or 
forehead. 

First to fourth day 
of fever, on trunk 
and shoulders. 



Fourth 
fever, 
head. 



day of 
on fore- 



First to fourth day 
fever, on face. 

Second day of 
fever, on trunk. 



No eruption; rash 
sometimes on 
second or third 
day of fever. 



Period of Infec- 
tion. 



Three to seven 
weeks. 



Four weeks ; un- 
til every scab 
has fallen. 

During initial 
symptbms and 
until end of des- 
quamation. 

Same as measles. 



End of desquama 
tion and com- 
plete disappear- 
ance of throat 
symptoms. 

Until all dis- 
charges have 
ceased and 
throat symp- 
toms have dis- 
appeared. 



I02 The Hygiene of the Schoolroom. 



Disease. 



Whooping 
cough. 



Typhoid fever. 



Yellow fever. 



Mumps. 



Period of 
Incubation. 



4 to 14, usually 
7 days. 



I to 26, usually 
12 days. 



I to 7, usually 
3 to 4 days. 



14 to 21 days. 



Appearance of 
Eruptions. 



No eruption. 



Sometimes spots 
on abdomen be- 
tween sixth and 
fourteenth days. 

Jaundice some- 
times on second 
day of fever. 

No eruption. 



Period of Infec- 
tion. 



During catarrhal 
stage and as 
long as whoop 
lasts. 

Until diarrhoea 
ceases. 



Uutil fever ceases. 



Until swelling has 
disappeared. 



Dr. Meredith Young, of Crewe, England, divides the 
contagious diseases into two classes, A and B. 

Those in Class A are : Scarlatina, diphtheria, measles, 
rubella, mumps, pertussis, varicella, vari'ola and influenza. 
In Class B are mentioned erysipelas, ringworm, diseases 
of scalp, scabies and purulent conjunctivitis. 

When diseases of Class A occur, all children living in 
the same house are excluded from school ; as for Class B, 
the exclusion of the patient alone is demanded. 

The objection to such a classification would be found 
in the difficulty of carrying out as stringent exclusion 
from school with influenza as with scarlatina. 

Usually the child that has received the infection re- 
mains at school while the disease is breeding. 



Contagious Diseases. 103 

Certain of the diseases enumerated have a character- 
istic eruption, viz. : smallpox, chicken-pox, scarlet fever, 
and measleSo These are known as the eruptive fevers. 
The time elapsing from the first symptoms of illness to 
the breaking of the eruption, or "rash," is spoken of as 
the period of "invasion." With smallpox it is from two 
to three days ; with measles, four days ; with scarlet fever, 
two days; with chicken-pox, one or two days. 

Thanks to the great discovery of vaccination by Ed- 
ward Jenner in 1798, smallpox has not now the important 
place in the list of school diseases it once had. Living 
in this generation, almost freed from this horrible plague, 
we can hardly picture the devastation this disease 
formerly caused. Macaulay, the English historian, called 
smallpox "the most terrible of all the ministers of death." 
Professor Wernher, in his work "Zur Impffrage," says : 
"Before the introduction of vaccination, smallpox had 
become a permanent disease which never entirely ceased 
in any one year, and every three or five years became a 
great epidemic. In non-epidemic years, one-tenth of all 
mortahty was from variola; in epidemic years, one-half. 
Very few men escaped smallpox till old age; almost 
every one sickened at least once in his life of this hor- 
rible, murderous disease. Countless mortals were maimed 
by loss of sight. Of new-born children, one-third died 



I04 The Hygiene of the Schoolroom. 

of smallpox before their first year; one-half before their 
fifth year of life. There was no family which had not 
had heavy losses to deplore. Men accepted the pest as 
an unavoidable fate. It was the principal factor which 
deterred or kept back the population from progress; yet 
the efforts of mjany ignorant mortals are directed toward 
a return to these conditions." Looking at present con- 
ditions, the same author says : "We now find no child 
mortality among vaccinated children; among adults also, 
whenever vaccination and revaccination are maintained, 
mortality from smallpox is at an end." That vaccination 
does prevent it is shown by Prussian statistics of the ap- 
proximate average annual rate of deaths from smallpox 
per million before the practice of vaccination and after. 
Before the introduction of vaccination the rate was 
3,321 ; after, only 56. 

An inspector of contagious diseases in New York said : 
"During our nine years of service in the Health Depart- 
ment of New York, I have never seen a case of small- 
pox in a person who had been vaccinated successfully 
within five years, and the number of cases I have seen 
mount into hundreds. During that period, I have seen 
only one inspector contract smallpox, and he was the only 
inspector who disbelieved in vaccination and refused to 
have it performed upon himself." 



Contagious Diseases. 105 

Drs. W. M. Welch and Jay F. Schamberg (Philadel- 
phia Medical Journal) give their experience in the Phila- 
delphia Hospital for Contagious Diseases. They state that 
in one year's experience (after 1901) about three hun- 
dred cases of smallpox were treated at this hos- 
pital. Of this number not a single patient had been re- 
cently successfully vaccinated. The shortest period 
elapsing between a successful vaccination and the con- 
traction of the disease was five years. In this case, 
which occurred in a boy of eleven years old, the eruption 
consisted of only a score of papules, which scarcely de- 
veloped into vesicles, and dried up in a few days. It 
was not found necessary to confine the lad to bed. While 
the majority of the patients admitted were unvaccinated, 
a very large number had been vaccinated in infancy. To 
the best of the writer's knowledge, none, save the boy 
mentioned, had been successfully vaccinated within the 
past ten years. The writers believe that it may be laid 
down as a rule that if a child be successfully vaccinated 
in infancy, and again at the age of puberty, the protection 
will be permanent. The exceptions to this rule, how- 
ever, may be sufficiently frequent to warrant a repetition 
of the vaccination whenever there is exposure to small- 
pox. They prefer the glycerinated lymph in such cases. 
Smallpox seldom manifests itself in the school, and 



io6 The Hygiene of the Schoolroom. 

the only phase of this subject of interest is that of vac- 
cination. Immunity from smallpox in recent years has 
made the people careless and even defiant of the laws 
governing vaccination. The "anti-vaccinationists" have 
in many places defied the school authorities who de- 
manded compulsory vaccination among school children. 
It is strange that such a blessing can be so lightly looked 
upon ; and it usually requires several cases of smallpox in a 
community before the people will avail themselves of the 
opportunity to be vaccinated. It should be borne in mind 
that vaccination and modern sanitary science have almost 
wiped smallpox from the face of the earth, and that any 
relaxation of the means that secured this desirable end 
may serve to bring back the scourge once more. All 
children should be vaccinated before entering school, 
unless the health officer can satisfy himself that the state 
of the child's health is such as would make the operation 
inimical to him. 

Compulsory vaccination is demanded by most school 
boards and state laws. A number of complaints, how- 
ever, have been noticed within the past two years, of 
laxity on the part of school boards in relation to the vac- 
cination laws. In many cases it is because the parents 
do not believe in efficacy of inoculation, or because they 
fear some evil result. But the proverbial vaccination 



Contagious Diseases. 107 

stories, telling of horrible results, are gross exaggera- 
tions, not to be credited, as in not one case in a thousand 
are any untoward results noted. 

School boards should always require each child upon 
entering the schools to be successfully vaccinated. This 
means that if the inoculation fails to "take" at the first 
trial, it should be repeated again and again until it 
does "take." Usually the certificate given to a success- 
fully vaccinated child when entering school is allowed 
to stand indefinitely; but as the immunity is supposed to 
disappear in from five to seven years,, revaccination 
should be insisted upon from time to time. 

When smallpox is epidemic in a community all the school 
children should be vaccinated regardless of previous 
scars. If the immunity still continues, the vaccination 
will have no effect, and if successful it only proves the 
necessity of the added safeguard. There may be some 
few children in a community who, for physical reasons, 
should be excused from vaccination; but the number 
rightfully excluded would be very small. Pressure is 
often brought to bear upon the physician by the parent 
for a certificate of exemption, and it would be wise for 
school boards to demand the signature of two physicians 
to such a certificate. 

The U. S. Marine Hospital Service, in its bulletin on 



io8 The Hygiene of the Schoolroom. 

"Smallpox," decries the necessity at all of such exemp- 
tions and pointedly says that there are only two classes in 
a community who deserve to be exempt — "first, those that 
have already had smallpox, and, secondly — those that are 
dead." 

Chicken-pox is a harmless disease which has interest 
only from its liability to be mistaken for smallpox. It 
manifests itself in the shape of small, round rose-colored 
sores scattered over the body. But however mild it is in 
Its nature, no child suffering from it should be allowed 
at school. 

The three great "school diseases" of this clime, both 
because of their frequency of appearance and the serious- 
ness of their nature, are measles, scarlet fever, and diph- 
theria. This does not mean that they are serious because 
they always destroy life, but because of the troublesome 
after-effects they leave upon the eyes, the ears, and the 
voice. 

Measles, though the least likely to be fatal, is the most 
infectious of all, beginning to be so several days before the 
eruption breaks out. A child coming down with it 
exhibits symptoms of a severe cold; has headache, stop- 
page of the nose, tickling of the throat, sneezing, in- 
flamed, watery eyes, and a hard, dry cough. The erup- 
tion is in the shape of small, red dots resemibling flea 



Contagious Diseases. 109 

bites, first appearing on the temples and the forehead, 
and later spreading over the entire body. Pneumonia 
often complicates a case of measles, making a serious 
combination. A lingering cough or inflamed eyes and 
ears may follow. The patient should keep his bed for a 
week and his room for three weeks. If well by this time, 
he may rejoin his playmates. When a case enters a 
household where other children are, all should be enjoined 
from attending school. Epidemics of measles usually 
begin in cold weather. 

Scarlet fever, or scarlatina, is a limited contagious 
disease caused by a specific germ, and characterized by 
fever, sore throat, and an eruption. This eruption is of 
a bright scarlet, forming first on the chest and the upper 
extremities. About the fifth day of the fever, the rash 
begins to peel off, and then especial care should be taken, 
as at this time the disease is most infectious. Contagion 
may come through such mediums as library or school 
books, letters, clothing, or toys. Chronic nasal catarrh, 
pneumonia, heart and kidney trouble, may complicate and 
follow this disease, but what is most of all to be feared is 
the ear trouble, where the drumhead becomes perforated 
and a chronic discharge follows. One observer, upon 
investigating causes of deafness in four hundred persons, 
found scarlet fever to be responsible for one hundred and 



no The Hygiene of the Schooh'oom. 

forty- four of that number. A child should not be al- 
lowed to return to school until four weeks after recovery, 
as the disease continues to be infectious long after the 
patient is apparently restored to health. 

Of the common diseases incident to school life, diph- 
theria is the most destructive. In recent years, the dis- 
covery and use of antitoxin have considerably lessened 
the mortality, but it is £till a difficult disease to combat. 
Its duration is usually short and its progress rapid. Its 
constant feature is the presence of a white patch or 
patches in the throat, accompanied by high fever and 
weakness. Many cases are of such slight nature and the 
constitutional symptoms so light that little notice is paid 
to the affection by careless parents, and the child con- 
tinues at school, infecting all about him. Peculiarly 
enough, however, the mildest case of this disease may 
infect another child with the most violent type. 

If there should be no medical inspector connected with a 
school, it is an easy matter for the teacher, in all cases 
of "sore throat" coming under her notice, to make an 
examination by depressing the back portion of the 
tongue with a small, clean piece of wood. If there are 
shown in the throat any small white spots or patches, the 
child should be immediately sent home to be examined by 
a physician. It is true that white patches in the throat 



Conta2:ious Diseases. iii 



*-& 



do not always indicate diphtheria, but the teacher should 
not be expected to differentiate. That can best be done 
by a physician, and then only after a culture is taken 
from the throat to be examined under the microscope for 
the detection of the presence of diphtheria bacilli. Diph- 
theria patients should be carefully isolated and pupils 
from the same family kept from school. The child may 
be returned to school, if good disinfection has been car- 
ried out, three weeks after recovery. 

Whooping-cough is a disease far too lightly considered 
both at home and at school. Ordinarily, little attention 
is given to it by the school authorities. Children are 
often allowed to continue at school while suffering from 
it, infecting those around them at every cough, and an- 
noying all present by each spasmodic outburst. And, 
although in most cases the child recovers, whooping- 
cough is far more dangerous than is usually supposed. 
Dolan ranks it third among the fatal diseases of child- 
hood in England ; and Smith, in New York, states that 
one out of every seventy-six deaths there is due to whoop- 
ing-cough. It is not alone in the disease itself that the 
mortality lies, but in the complication so often resulting, 
such as convulsions and pneumonia. Children with this 
disease should be kept from school until the physician 
certifies to complete recovery. Unfortunately, the dis- 



112 The Hygiene of the Schoolroom. 

ease is a long-standing one, running from six weeks to 
as many months, and parents will protest strenuously 
against having the child excluded from school for this 
long period of time. There is no alternative, however, 
when we consider the extreme contagiousness of whoop- 
ing-cough and the great distress the infliction of the 
disease on others would cause. 

Tuberculosis, or, as it is popularly called, consumption, 
is sometimes encountered in the schoolroom. Since the 
discovery by Koch of the cause of tuberculosis, the con- 
viction of late years has grown that this disease is com- 
municable and to a great measure preventable. With a 
view to preventing the spread of tuberculosis, the Board 
of Health of New York City issued the following in- 
struction : 

"Consumption is a disease which can be taken from 
others and is not simply caused by colds. A cold may 
make it easier to take the disease. It is usually caused 
by germs which enter the body with the air breathed. 
The matter which consumptives cough or spit up contains 
these germs in great numbers : frequently millions are 
discharged in a single day. This matter, spit upon the 
floor, wall, or elsewhere, is apt to dry, become pulverized, 
and float in the air as dust. This dust contains the 
germs, and thus they enter the body with the air breathed. 



Contagious Diseases. 113 

"The breath of a consumptive does not contain the 
germs and will not produce the disease. A well person 
catches the disease from a consumptive only by in some 
way taking the matter coughed up by the consumptive." 

A child known to be suffering from tuberculosis must 
of necessity be excluded from school. With this disease 
the outward signs noticeable to a teacher would be 
cough, paleness of the skin, difficulty of breathing, and 
weakness. Any pupil who continues to cough for some 
time should be examined and a physician's opinion be 
requested as to whether the trouble is contagious. Ex- 
pectoration upon the floor should be forbidden at all 
times, whether a cough be present or not. 
, Mumps, or parotitis, is an acute infectious disease, 
outwardly manifested by swelling of the parotid gland, 
which lies immediately below the external ear. Mumps 
will be encountered in the schoolroom more often than 
any of the diseases previously spoken of, as the child 
usually complains but little of sickness, and the infectious 
nature of the ailment is not rightly recognized. It is not 
dangerous to life, but should be guarded against by re- 
fusal to admit any child suffering from this disease. 

Typhoid fever is very apt to manifest itself during 
school life, as a large number of cases occur between the 
ages of five and fifteen. Besides being an especially 



114 The Hygiene of the Schoolroom. 

dangerous disease, it deprives the child of the advantages 
of school for a long period of time, often many months. 
It is known to be contagious, and often the avenue of the 
disease is polluted milk or drinking water. If the water 
of a school is from the public water supply of a city, 
there are authorities who are supposed to analyze it care- 
fully from time to time for the presence of any disease- 
breeding impurities. If the supply be on the grounds, 
from a well, it should have a careful analysis at least 
twice a year to determine its purity. 

Should two or three or more cases of typhoid fever be 
reported from a single school, the closest examination 
should be given to the building, lest the cause should be 
there. The water supply, the drainage, the closets, and 
the cellar, should be the subjects for investigation. 

Typhus fever, cerebro-spinal meningitis and erysipelas 
are contagious diseases which it will usually require a 
physician to discover. When epidemic, they require the 
same precautions as spoken of with the foregoing dis- 
eases. 

Certain inflammatory diseases of the eye and skin are 
contagious. Any child found with sore, watery eyes, or 
scabby sores upon the body, or that peculiar skin disease 
known as "ringworm," should be sent out as being the 
subject of a contagious disease. In some of the large 



Contagious Diseases. 115 

centres of population contagious eye diseases and ring- 
worm are a source of great concern to the school author- 
ities. In New York Cit}^ in 1902, out of 55,000 pupils 
examined, 6,670, or about 12 per cent, were suffering 
from contagious eye diseases ; 2,328 of this number had 
trachoma (granular lids). Ringworm has been especially 
common in the larger cities, where the foreign element 
predominates. It is a stubborn disease to combat and 
lasts many weeks. In order that those suffering from it 
may not be deprived of all their school benefits it has been 
recommended that separate schools be opened for those 
suffering from ringworm or trachoma. This expedient 
has been successfully tried in parts of Italy and Belgium. 
The diseases described are all, to a greater or less 
extent, communicable, and also largely preventable. No 
greater good can be done in school work than by the 
study and application of hygiene to prevent these same 
diseases, which annually make such ravages among chil- 
dren. The diseases for which pupils are excluded from 
school attendance are scarlet fever, diphtheria, tonsilitis 
(in Philadelphia and Detroit), measles, mumps, chicken- 
pox, whooping cough, pediculosis, scabies, impetigo, tu- 
berculosis, smallpox, and trachoma. No matter how 
carefully children may be cared for at home, they must 
rub shoulders with others who know little of the laws of 
personal cleanliness. At home a child may drink only 







A 



Fig. 26. 

Sanitary Drinking Fountain. 



Contagious Diseases. 117 

from his own cup, but at school he too often drinks from 
a filthy tin dipper that a hundred lips have touched that 
day. The wonder is that disease is not more common in 
our schools. It behooves us, then, to study all condi- 
tions that will serve to lessen this great interchange of 
disease. 

First, we must revert to ventilation again, and con- 
sider that disease germs find a paradise in a close, poorly 
ventilated room. We should also abolish the common 
drinking cup. It should not be tolerated for one day in 
a schoolroom. Each child should have a marked cup of 
his own and use that only. 

An admirable means of preventing the spread of many 
diseases is by substituting for the drinking cup or tin 
dipper a drinking fountain, which has been patented, 
by means of which the pupil, pressing a small 
lever in the floor with the foot causes a gentle stream of 
water to be thrown upwards. The child places the lips 
to this stream and drinks ; the water flows back into a 
basin and out. Removal of the foot from the lever stops 
the supply of water. The great advantage is that the child 
drinks readily and without touching the lips to any cup or 
dish of any kind. This appliance in actual use is shown 
in the illustration opposite. Too much cannot be said for 
this device; its general use would undoubtedly cause a 
marked diminution of contagious diseases. 




Fig. 27. 

Sanitary Drinking Fountain in use. 



Contagious Diseases. 119 

The pupil should be enjoined from the very common 
habit of wetting the thumb or fingers with saliva to 
turn the leaves of a book. This is an unsanitary practice 
and an easy way of introducing disease germs into the 
mouth. 

The practice of carrying home books or other school 
articles should be carefully looked after and forbidden in 
cases where contagious diseases exist. If, by some over- 
sight, such articles are left at homes where there are such 
diseases, they should be thoroughly fumigated with for- 
maldehyde vapor before they are returned to the school. 
This fumigation can easily be carried out by placing the 
books and articles in question in a small closet, closing 
the door and stopping up the keyhole and burning one or 
two formaldehyde candles. The books should be set on 
edges with the leaves opened as much as possible. 
When smallpox, diphtheria, or scarlet fever is epidemic in 
a community, the carrying of any articles from school 
to home should be prohibited. 

The use of pencil and slate is rapidly passing away, 
and the pad of paper and lead pencil are being substituted. 
It is impossible to keep the old slate clean, and usually 
the attempted cleaning is done with saliva. Its use also 
involves the necessity of sponges and slate cloths, which 
are ready germ catchers. When slates are in constant 



I20 The Hygiene of the Schoolroom. 

use it would be well to have them washed weekly with 
a I to 5,000 solution of bichloride of mercury. 

No common towel should be used at school. Con- 
tagious skin and eye troubles find a ready mode of inter- 
change through the towels. If they are at all necessary, 
there must be one for each pupil. Schools that are in use 
both day and evening demand extra care in regard to 
ventilation and cleanliness. 

When a severe epidemic visits a particular school, 
neighborhood, or city, there should be no hesitancy in 
closing all the schools endangered. This, as has been 
proved repeatedly, will usually suffice to stop the spread 
of the disease. Dr. Walford, an English medical officer 
of health, says: "I am aware that it is frequently stated 
that on the closure of schools, children will play together 
in the streets or meet in houses, and that the epidemic 
will thus spread still more. Doubtless under these cir- 
cumstances, thei"e is a probability of some infected chil- 
dren coming in contact with healthy ones, but the danger 
of spreading the infection must be infinitely greater when 
a large number of children are congregated together for 
hours in overcrowded and badly-ventilated schoolrooms." 

If, during the prevalence of an epidemic, the schools 
are not closed, it is feasible and advisable to fumigate the 
rooms often by the use of formaldehyde vapor. This 
can easily be done by the janitor after school hours. The 



Contagious Diseases. 121 

following method of disinfection of a room and its con- 
tents is recommended : 

"i. All cracks or openings in plaster or floor and 
about the door and windows should be closed by cotton 
or strips of cloth. 

"2. The books, papers, pencils, etc., should be spread 
out upon desks, chairs and tables in order to expose as 
much surface as possible to the disinfectant. They 
should not be thrown into a heap. 

"3. For each 1,000 cubic feet of space 150 centimeters 
(five ounces) of formalin should be placed in the distill- 
ing apparatus and distilled as quickly as possible. 

"4. The keyhole and spaces about the door should 
then be packed with cotton or cloth. 

"5. The room should then remain closed for at least 
ten hours." 

The use of disinfectants such as a solution of 
carbolic acid (one part to fifty parts of water), mer- 
curic chloride (one part to a thousand parts of water), 
and permanganate of potassium (one part to a thousand 
parts of water), about the water-closets is always ad- 
visable, and especially so in epidemics. Many janitors 
place too much reliance on disinfectants, and think that 
no matter how filthy a corner may be, liberal sprinkling 
of chloride of lime, or some such agent, will immediately 
purify it. The best disinfectant is cleanliness, which 



122 The Hygiene of the Schoolroom. 

should always be the advance guard of the other means 
employed. 

Schools that have the benefit of the daily examination 
of the medical inspector are indeed fortunate, as the 
burden of a great responsibility is taken from the teach- 
ers. In schools not so fortunate, the teacher should make 
careful daily inquiries regarding the health of .the pupils 
and also the health of the other inmates of the pupils' 
household. In this way many contagious diseases will 
be discovered and reported to the proper official for in- 
vestigation. Many families treat, without a physician's 
aid or any attempts at isolation, such diseases as diph- 
theria, measles, and scarlet fever, often being afraid to 
report to the Health Board, lest the laboring members 
of the family may be denied their usual work. 

Every school board should adopt careful and stringent 
regulations regarding contagious diseases and the school. 
The Health Board of the City of New York has approved 
a number of recommendations suggested by Professor 
Herman M. Biggs, the department bacteriologist, and 
ordered that a copy be sent to the Board of Education. 
Some of the recommendations are as follows : 

"i. The use of slates, slate pencils, and sponges shall 
be discontinued in all the public schools. 

"2. According to requirement, pupils shall be supplied 



Contagious Diseases. 123 

with pencils and penholders, each pupil to retain those 
received in a box provided for the purpose, such box to 
be marked v/ith the pupil's name. Pencils and penholders 
shall not be transferred from one pupil to another without 
suitable disinfection. 

"3. All school property left in the school building by a 
child sick with any contagious disease, and all such prop- 
erty found in an apartment occupied by a family in which 
a case of smallpox, typhus fever, diphtheria, scarlet fever, 
or measles has occurred, shall be taken by the Health 
Department for disinfection or destruction. 

"4. Books which are taken home by pupils shall be 
covered regularly once a month with brown manila paper. 

"5. Places for drinking water on the ground floors of 
the school buildings shall be discontinued, and a covered 
pitcher provided for each classroom, in which fresh water 
shall be placed before every session. A numbered cup to be 
kept in the classroom shall be issued to each pupil. No 
interchange of cups shall be allowed. 

"Provision is proposed for the exclusion of children in 
whose homies there may be cases of contagious disease, 
and for a report by teachers to the Board of Health of all 
cases of sickness among the pupils. Finally, the recom- 
mendations provide for more closet room for hanging 



124 The Hygiene of the Schoolroom. 

clothes, and prohibit principal and teachers from sending 
one pupil to the house of another for any reason." 

Teachers or the medical officer should teach the pupils 
the great advantages of daily bathing and the immunity 
from contagious diseases it affords. The medical director 
of a boys' boarding school in England stated that the 
daily practice of head to foot bathing in his school reduced 
infectious diseases to one-third of the number previous 
to the establishment of this practice. In some schools 
instruction must go still farther; children should be en- 
couraged to be clean in person and clothes, especially the 
underclothes. So much of disease is given off by the 
skin and so much disease finds its way into the body 
through the skin that it is essential for a healthy body to 
have a clean, active skin. This cannot be had when 
changing of underclothes is neglected and accumulated 
dirt blocks up the small invisible pores of the skin. 

Often a teacher may wish to know whether a complain- 
ing child is really ill or only affecting to be so. During the 
presence of an epidemic it would be wise for the teacher 
to take the temperature and pulse of the child. To obtain 
the temperature, or bodily heat, it is necessary to have a 
small clinical thermometer, the bulb of which is placed 
underneath the tongue, with closed lips, and allowed to 
remain there three minutes. Normally, when removed 



Contagious Diseases. 125 

it should be 98.2°F, and any elevation of this should be 
noted and the child sent home. When a thermometer is 
used, it should first be thoroughly cleansed and shaken 
so that the mercury will stand lower in the column than 
the normal point. The pulse of healthy children of 
school age will vary from 72 to 80. 

Acute anterior poliomyelitis, or infantile paralysis, has 
become within the past three years a serious condition 
demanding the attention of health and school officials. 
The disease has been long known to medical science and 
is in no sense " new," but its tendency to occur in serious 
epidemics seems to be on the increase. 

Epidemics in Italy were reported as far back as 1856, 
but only for the past three years has it been so prevalent 
in America. Fortunately it is generally a disease of the 
summer months, when children are out of school and 
contagion less probable. 

In Rhode Island the distribution as to months and 
ages for 19 10 was as follows: 



March. 


April. 


May. 


June. 


July. 


I 





4 


5 


46 


August. 


September. 


October. 


November. 


December. 


70 


65 


9 


4 


2 



126 The Hygiene of the Schoolroom. 
By ages: 



Under i year. 


1-3 years. 


3-5 years. 


23 


81 


52 


5-10 years. 




10 years and over. 


28 




22 



Of those cases over ten years of age there were 3 at ten 
years; 3 at twelve years; i at thirteen years; 5 at 
fourteen years; i at fifteen years; 4 at sixteen years; i 
at eighteen years; 3 at nineteen years; i at twenty-four 
years. 

The causative factor is probably some form of bacteria, 
ahhough its definite nature has not been determined. 
Flexner, of New York, has made valuable studies in 
proving the contagious nature of the disease, and many 
research laboratories are now at work on the problem. 
Unfortunately, it is not a disease that can be recognized 
in advance by any signs heralding its approach, as the 
beginning symptoms are those common to many ailments 
of children. 

Usually fever and vomiting, perhaps diarrhoea, are 
noticed, and the paralysis of one or both legs follows in 
from one to four days without any other warning. The 
arms, muscles of the face, neck, and back are also some- 
times involved. 



Contagious Diseases. 127 

The paralysis, which finds its origin in the anterior 
horns of the spinal column, may be permanent or may 
improve, with partial restoration of functions, or entire 
recovery may result. It has been definitely decided that 
it is a contagious disease, and many states make it 
mandatory upon physicians to report every case to the 
health authorities. 

The Rhode Island State Board of Health, after an 
extensive experience with infantile paralysis, oft'ers the 
following suggestions as best in keeping with our present 
light on the subject: 

Quarantine or precautions against spread of the 
disease: As with all other communicable diseases, the 
practice varies with the intelligence and environment 
of the cases. Having the history of so few cases succeed- 
ing in families where many children have been living 
together and in institutions where many children are 
brought into the closest contact with the patient, it 
would seem that quarantine to be imposed should reach 
only so far as shall give the least unnecessary annoyance 
to those who are associated with the cases affected. In 
the presence of our present limited knowledge of the 
mode of infection, it is deemed desirable to separate the 
case from other members of the family, except for the 



128 The Hygiene of the Schoolroom. 

necessary attendance of the nurse. Immediate disin- 
fection by hot water should be made of all the secretions 
coming from the mouth of the patient, and of the excreta, 
also of all utensils which have been in contact with the 
patient's mouth, including cups, spoons, food, and not 
forgetting the clinical thermometer. 

This isolation of the patient should be kept up for 
the probable period of contagion or transmissibility, 
which may be considered a period of four weeks. The 
period of quarantine ot the unaftected children in the 
family should be for the maximum assumed period of 
incubation, namely, fourteen days, and for discontinuance 
of the isolation of the patient, about twenty-eight days, 
or twice the period of incubation, dating from the day 
of the appearance of the paralysis. 

While these periods are arbitrary, and it may be 
assumed by analogy with diphtheria that the infectious 
material remains in the throat for a long period, yet it 
is a sensible working basis in the present lack of knowl- 
edge. It is not necessary — in fact, it is not desirable — 
in most cases to close the public schools. During the 
school session, which covers many hours of the day, the 
children are not in condition to communicate material 
from mouth to mouth except by the common drinking- 



Contagiou's Diseases. 129 

cup, and the exchange of school pencils and books which 
have been thumbed. In case school is not in session, 
many of the children are liable to come into close con- 
tact in play for more hours in the day. The failure of 
the disease to spread in institutions where hundreds of 
children are bunched together would not indicate that 
such association in school was especially objectionable. 

Prognosis. 
Out of 628 cases carefully studied by Lovett, of the 
Massachusetts State Board of Health (as to the re- 
sult of the paralysis), 62 (or 10.8 per cent.) recovered. 
Four hundred and four failed to recover, 61 recovered 
partially, and death ensued in 50 cases (7.9 per cent.). 
In 50 cases no report was given as to the result. The 
results appeared in no way to be mfluenced by the age 
of the patient. 



CHAPTER XI 

Medical Inspection of Schools 

Among the diseases known commonly as ''school dis- 
eases," some have been discussed as being contagious, 
others as non-contagious; but all are to a greater or less 
extent preventable, either by discovery and isolation or 
by better application of hygienic detail. Within the last 
decade, in the larger cities of this country and Europe, 
the plan has been adopted of having a regularly appointed 
medical officer, whose duties are a daily examination of 
all suspected illness, whether contagious or not ; a regular 
examination of each child's sight, hearing, and seating; 
and an investigation as to proper heating and ventilating 
of the schoolroom. At first some objections were raised 
to the adoption of such a practice. The expense was de- 
plored, but in most instances the fees of the inspector 
were fixed at a merely nominal sum of one or two hun- 
dred dollars a year. Some physicians selfishly objected, 
protesting that the discovery of some of the "school dis- 
eases" would serve only to enlarge the practice of the 
inspector ; but the rules formulated gave the inspector no 



Medical Inspection of Schools. 131 

authority to prescribe medicines. The child was sent 
home and the case treated by the family physician. Being 
a new thing, it, like many other innovations beneficial to 
the people, was looked upon by some with little favor. 
But the establishment of school inspection in a city meant 
always its retention, for the benefits derived were con- 
spicuous and the only wonder was at the folly of having 
lived so long without it. 

In Boston, for the first fourteen months of medical 
inspection, 16,700 cases were examined, and during 
that time were discovered 'jy cases of diphtheria, 28 
of scarlet fever, 116 of measles, 28 of chicken-pox, 
69 of pediculosis (lice), 47 of mumps, 33 of whooping- 
cough, 47 of scabies or contagious itch, 8 of con- 
genital syphilis, a large number of contagious dis- 
eases of the eyes, and 2,000 cases of follicular tonsilitis. 
Following is the report of the health department of the 
city of Boston for 1900, when there were examined by the 
medical inspectors of the public schools 15,573 children. 

Specific infectious diseases 505 

Oral and respiratory diseases 2,609 

Diseases of the ear yj 

Diseases of the eye 431 

Diseases of the skin 3j42I 

Miscellaneous diseases 3^568 

Found free from disease 4,952 

15,573 



132 The Hygiene of the Schoolroom, 

Of the infectious diseases, there were : diphtheria, 23 
cases; scarlet fever, 23; measles, 121; whooping- 
cough, 62; mumps, 107; chicken-pox, 108; influenza, 50; 
erysipelas, 2; syphilis, 3; tuberculosis, 2; malaria, 4. 
There were 438 cases of acute pharyngitis, 1,281 of acute 
follicular tonsilitis, 58 cases of adenoid disease, 220 cases 
of im.perfect eyesight (without visible cause), 337 cases 
of eczema, 227 of impetigo contagiosa, 2,316 of pedi- 
culosis (lice,) 42 of scabies (itch) ; of tinea favosa and 
tinea trichophytina (ring-worm), 172; of headache 
(habitual), 206; of urinary diseases, 29. 

In New York city, during the first four days of medical 
inspection in the public schools, 400 cases of contagious 
disease were discovered and dismissed from school until 
danger from contagion had passed. The report of the 
results of medical inspection of the public schools in New 
York city shows that for the quarter ending June 30, 
1897, there were 220 schools inspected each day by 149 
medical school inspectors. The total average attendance 
was 149,520. Of this number, 63,812 children were 
examined as suspects, of whom 4,183 were found to be 
affected with some contagious disease and excluded from 
the schools. This makes over six per cent, of the total 
examined. Of these cases of contagious diseases, 167 
were cases of diphtheria; 32 scarlet fever; 88 measles; 



Medical Inspection of Schools. 133 

II croup; 26 whooping-cough; 117 mumps; 702 con- 
tagious diseases of the eye ; 2,627 parasitic diseases of the 
head, 108 of the body; 130 chicken-pox; 175 skin diseases. 

Of the true cases of measles and of scarlet fever all 
were in the stage of desquamation. This would naturally 
be the case, inasmuch as these diseases, in the beginning, 
are marked with a certain amount of fever and discomfort 
which leads the parents to retain the children at home, 
after which the rash appears, and the case is then ex- 
cluded fromi the schools. But there are certain cases in 
which the constitution of the patient is such that the 
fever is unappreciable ; and the child, having a slight 
rash only, is given little notice by the parents, and con- 
tinues at school until desquamation occurs, when probably 
a new crop of cases will be produced. 

To quote the report : "As a rule, among a large num- 
ber of people having children that attend school, no 
dread of these diseases, so common to childhood, is felt ; 
and either through indifference or selfishness they refuse 
to believe that these diseases are avoidable, and often 
oppose the use of the proper means for their prevention. 

"A glance at the totals of the various diseases for which 
children have been excluded during the sixty-five school 
days of the past three months shows the carelessness and 
ignorance of many parents in regard to the spreading of 



134 The Hygiene of the Schoolroom. 

infectious and contagious diseases. Not thinking of, and, 
perhaps, not caring about, the danger, they send their 
children, carrying the germs of these diseases, into the 
crowded schoolroom, and necessarily expose, and, no 
doubt, infect many other children. 

"These results also show the importance of the med- 
ical school inspection as one means of preventing the 
spread of these diseases ; and with this work further ex- 
tended and perfected, and with the education of the 
parents and guardians as to the necessity of keeping in- 
fected children at home, we shall be able to reduce the 
number of these diseases among the children of this city." 

In 1903, the first year of medical inspection in Provi- 
dence, R. I., "1,018 children were found to be in an ab- 
normal condition. Three had diphtheria ; five, scarlet 
fever ; twenty-three, German measles ; eighteen, enlarged 
tonsils; and 182 cases of adenoids were found. In the 
latter cases much of the backwardness of the children is 
accounted for, and in the discovery of that malady alone, 
say the physicians there is sufficient evidence of the merit 
of the inspection, as by prompt treatment of the throat 
growth those 182 children will be placed in a condition 
on a par with healthy children. Much also of the sup- 
posed ignorance of the children will have been done 
away with, as that particular trouble affects greatly the 
faculty for learning. There were thirty-one children 



Medical Inspection of Schools. 135 

found to be affected with ear trouble, seventy-two with 
petty eye troubles, and nearly 160 with imperfect vision, 
133 had skin diseases, ten had spinal trouble, and five 
had paralysis. Twenty were adjudged to be mentally 
deficient." 

The Bulletin .of the Department of Health of Chicago, 
of March 2, 1907, shows that of 48,1 55 pupils examined, 
7,205 or nearly fifteen per cent, were at that time suffer- 
ing from a communicable disease. In Massachusetts, 
during the school year of 1906-07, out of an average 
school attendance of 343,000, 27,342 were reported as 
suffering from diseases and defects demanding attention. 

From statistics gathered from medical inspectors' re- 
ports in Berlin, New York, Boston, and Chicago, it ap- 
pears that about six to fifteen per cent, of the pupils 
attending the average public school are suffering from 
some one or other of the diseases enumerated, and 
are a source of danger to those with whom they come in 
contact. The medical profession has co-operated to the 
extent of giving its services at a very moderate figure: 
no school, then, in this broad land should be without a 
medical officer. It , needs no stretch of imagination to 
believe that if this practice is made general, thousands 
of lives of children will be saved, and thousands by this 
protection be spared the ordeal of long periods of illness 
and the enforced loss of valuable time at school. 



136 The Hygiene of the Schoolroom. 

Dr. Reynolds, health commissioner of Chicago, says 
that he knows of no other single living effort in which his 
scanty force of inspectors has engaged that has been of 
more obvious and direct benefit to the community in gen- 
eral, as well as to the school children themselves. 

In Berlin, after a serious epidemic of measles which 
paralyzed for a time the school system, public meetings 
were held; and the following resolutions were adopted 
and afterwards put into practice : 

"Laymen and physicians demand that each school have 
a physician assigned to it, to have charge of the general 
hygiene of the building and be watchful over the health 
of scholars ; to see to the proper heating, ventilation, 
cleanliness, and, if necessary, disinfection of the building ; 
to order the closing of the school when the heat becomes 
excessive, and in times of epidemics ; furthermore, to 
examine new scholars ; in short, the physicians should 
protect the scholars against the dangers of school life." 

Dr. Samuel H. Durgin, chairman of the Boston Board 
of Health in 1897, describes the working of the system in 
Boston. The Board of Health divided the city into fifty 
districts, giving an average of about four schoolhouses 
and fourteen hundred pupils to each district. No diffi- 
culty was experienced in finding well qualified and dis- 
creet physicians who would undertake the duties pre- 



Medical Inspection of Schools. I37 

scribed, and the board selected and appointed a physician 
for each district with a salary of $200 a year. His duty 
is to make a visit to each master's school daily, soon after 
the beginning of the morning session. The master re- 
ceives from the teachers in his district early reports as to 
the appearance of illness in any pupil in their charge; 
these reports are given to the visiting physician, who at 
once examines the reported children and makes a record 
of his diagnosis and action in books furnished by the 
Board of Health for this purpose and kept in the custody 
of the master. If the visiting physician finds the child 
too ill, from any cause, to remain in school, he advises the 
teacher to send the child home for the observation and 
care of its parents and family physician. If the illness 
is from a contagious disease, the child is ordered home 
and the case reported to the Board of Health. The dis- 
position of the sick child while at home and the proper 
isolation in cases where contagious diseases develop in 
such children, as well as the giving of a warrant for re- 
turning to the school, depend principally upon the report 
of the school inspector. 

The Health Department of New York City has the 
best and most specific rules for the medical inspectors. 
They are as follows : 

"Inspectors are required to report at the schools to which 



138 The Hygiene of the Schooh-oom. 

they have been assigned from 8.50 to 9.30 a. m. every 
day that school sessions are held. They are to examine 
carefully each child that has been isolated by the teachers 
in charge, and cause to be excluded from school each 
one affected with, or showing symptoms of, any con- 
tagious or infectious disease, more especially the follow- 
ing : measles, diphtheria, scarlet fever, croup, whoop- 
ing-cough, mumps, contagious eye diseases, parasitic dis- 
eases of the head or body, or chicken-pox. They shall 
furnish each pupil that is to be excluded with a printed 
card, upon which they shall note the date, name, and 
location of the school, the name, age, and address of the 
child, and the reason for the child's exclusion. These 
cards, signed by the medical school inspectors, are to be 
taken home by the excluded pupils. Each day, before 
leaving a school, each inspector is required to fill out a 
printed daily report blank, giving the date and time of 
visit, the name, location, district and card numbers of the 
school, the number of children examined (male, female, 
and total), the full name, age, and address of each one 
excluded, and the diagnosis of each excluded case. Note 
is also to be made on the daily report of any bacterial 
culture that has been taken, giving the clinical diagnosis, 
and stating whether the pupil was excluded or not. On 
the last school day of each week, the printed sum- 



Medical Inspection of Schools. 139 

mary blank, on the back of the daily report blank used 
that day, is to be properly filled out for each school day 
of that week. Each day, as soon as possible after leaving 
the last school to be visited, inspectors are required to 
mail a separate daily report (properly folded and 
"backed") for each school visited, to the chief inspector 
at the central office, where a daily summary is made of 
the work performed in all the schools visited. 

"All children excluded from school for measles or scar- 
let fever are visited at their homes within twenty-four 
hours by one of the diagnosticians of the board, and such 
cases are not tabulated as true ones unless he confirms 
the diagnosis, when a department postal card is sent to the 
school, excluding the child until after his complete re- 
covery. When the necessary disinfection and fumigation 
of the rooms where the child lives have been attended 
to, a certificate allowing him to return to school is issued. 

"Pupils excluded for chicken-pox are visited at their 
homes by the medical inspectors of the Division of Con- 
tagious Diseases having charge of the districts in which 
the children live ; when they confirm the diagnosis, the 
cases are recorded as true ones, and the schools notified 
by department postal cards. 

In cases of suspected diphtheria, when there is well- 
marked clinical evidence in the throat at the time of the 



140 The Hygiene of the Schooh-oom. 

examination, the child is to be excluded, after a culture 
has been taken; when the clinical evidence is not well- 
marked, a culture is to be taken, but the child is not 
to be excluded until a report is received by the medical 
school inspector from the Division of Bacteriology, stat- 
ing that an examination of the culture shows the presence 
of the Klebs-Loeffler bacilli.* In each case where an ex- 
amination of a culture taken by a medical school inspector 
shows the presence of the Klebs-Loeffler bacilli, a notice 
to that effect is promptly mailed to the maker of the cult- 
ure, and also to the medical inspector of the Division of 
Contagious Diseases in whose district the child resides, 
who then takes charge of the case as far as the proper 
isolation is concerned, taking subsequent necessary cult- 
ures, ordering disinfection and fumigation when the 
Klebs-Loeffler bacilli have disappeared from the throat, 
and issuing certificates for the child's return to school. 

"The district medical inspectors have the same surveil- 
lance over each case of measles or scarlet fever where the 
diagnosis made by the school inspector has been con- 
firmed by a diagnostician. When the result of an ex- 
amination of a culture, made by a school inspector, is 
negative, a report to that effect is forwarded to the chief 



* The Klebs-Loeffler bacilli is the germ that is the recognized cause of diphtheria. 



Medical Inspection of Schools. 141 

inspector, but not to the maker of the culture. When the 
examination of a culture made by a school inspector does 
not admit of an exact bacteriological diagnosis, and a 
prompt confirmatory culture is requested, such request is 
mailed to the maker of the culture, and also to the district 
medical inspector, in order that a confirmatory culture 
may be taken by the former, if the child is at school, or 
by the latter, if the child should be at hom.e. All cultures 
made by the school inspectors, accompanied by the 'cult- 
ure blanks,' properly filled out and signed, should be 
promptly forwarded to the nearest culture station. 

"Children excluded on account of whooping-cough, 
mumps, contagious eye diseases, parasitic diseases, etc., 
should be told to return when cured, and should be again 
examined before returning to their classrooms; if not 
entirely well they should be again excluded. 

"The inspectors are required to ascertain from princi- 
pals and teachers the names and addresses of all children 
from homes where there are contagious diseases, if notifi- 
cation has not been sent to the schools by the Board of 
Health; and such lists are forwarded with the daily re- 
ports. Inspectors keep daily records in blank-books, fur- 
nished for such purpose, of the number of children ex- 
amined (male, female, and total), the full names, ages, 
residences, and causes for exclusion of those excluded 
from school, and a list of cultures taken and forwarded. 



142 The Hygiene of the Schoolroom. 

"If, by reason of illness or other cause, an inspector is 
unable to report at a school, arrangements must be made 
with an inspector of another school to act as a substitute, 
and the chief inspector informed of the facts without un- 
necessary delay. 

"If, in the opinion of an inspector, immediate action 
should be taken by the Board of Health in any case, he 
immediately communicates by telephone with the chief 
inspector. Medical school inspectors report at the central 
ofifice once during each month. Exclusion cards for pu- 
pils, daily report blanks, addressed envelopes, blank-books 
for recording the work performed, wooden tongue de- 
pressors, culture outfits, and lists of culture stations, are 
furnished at the ofifice of the chief inspector. 

"The daily duties of medical school inspectors cease 
when they have mailed their reports, after leaving their 
schools. They are not, under any circumstances, to visit 
children at their homes, to prescribe for them, or suggest 
treatment at the schools. The treatment must be received 
from the family physicians, in the dispensaries, or in the 
hospitals." 



Note. After the necessary disinfection and fumigation of the rooms in which there 
has been an infectious or contagious disease, postal cards are mailed by the Division of 
Contagious Diseases, notifying the proper schools that it is safe to readmit the child or 
children living in those rooms. 



Medical Inspection of Schools. 143 

There should be no opposition from the. parents, on 
the ground of interference with the child's liberty ; on the 
contrary they should be pleased to know that their child 
is daily under a trained eye of a person who can more 
readily detect the onset of disease than they can, and 
whose only duty is to separate the infected child from his 
fellows, both for his own good and the good of the whole. 
Then, too, it must not be forgotten that disease will be 
earlier detected in its course and treatment begun at a 
more opportune time and with far better results. 

Under a perfect system the inspector will have mani- 
fold responsibilities. His duties will embrace regular 
examination of the eyes and ears. In this particular 
alone he will forestall measureless sufferings and thanks 
to him these organs will be preserved for a more useful 
future. By this same system of inspection he will avert 
many cases of spinal distortion and stooped shoulders, by 
seeing that each pupil is assigned a seat and a desk that 
is fitted to him and comfortable to use. Everything in 
the building that relates to its hygiene should be under 
his watchful eye. The heating, the temperature, the 
ventilation, the disinfection, and the sanitary closets 
would then be supervised by one competent to know the 
exact requirements of all these departments. 



144 The Hygiene of the Schoolroom. 

The school authorities outside the principal cities of our 
country have been slow to make use of the great ad- 
vantages of medical inspection. It is not a fad, — it is an 
ideal application of the "ounce of prevention." No 
school is too large for its scope and none so small that it 
can dispense with it. It is a safe prediction that another 
decade will find the practice general. Delay, therefore, 
in instituting the regular inspection of schools is not 
wise ; it is better to be a leader in a good movement, no 
matter how unpopular the movement may be at first, than 
to be dragged into it later from fear of the shame of 
standing opposed to public good. 



Note. — Medical inspection was primarily established for the discovery and preven- 
tion of communicable diseases, but no small part of its effectiveness has been its effect 
in non-communicable diseases, as the following record of children examined in New 
York city from March 28 to December 23, 1907, will show : 

Number of children examined 55i332 

Cases of bad nutrition 31823 

Anterior cervical glands I4i2i4 

Posterior cervical glands 3i047 

Chorea 738 

Cardiac disease 895 

Pulmonary disease 600 

Skin diseases 989 

Deformity of spine 485 

Deformity of chest 401 

Deformity of extremities 498 

Defective vision i6>394 

Defective hearing i,20 

Defective nasal breathing 6, 182 

Defective teeth 18,182 

Defective palate 689 

Hypertrophic tonsils 8,347 

Posterior nasal growths 5i>'i9 

Defective mentality 1,210 

Number of cases treated.. 33>S5> 



CHAPTER XII 
Modern Education and Health 

If one were to take note of the physical condition of 
children entering school, and again of the same children 
graduating from the high school, it would be found that 
many had suffered physical deterioration by this edu- 
cating process. 

The brain has been improved and developed and the 
body allowed to care for itself. If the school work lags 
behind, if the brain works badly, there are the teacher, 
the principal, and the superintendent to be consulted about 
it — yes, even the parent receives notification that the 
child's work is not up to the standard. If the bodily 
strength is not up to par, who cares? If the cheeks of 
the little one fade day by day, and the shoulders become 
more stooped and the chest more hollowed, who is noti- 
fied? Again, the child may keep the school work up to 
the standard, perhaps be the star pupil, and yet be poorly 
nourished, pale, sickly and undersized. No one regulates 
the amount of work to be done ; the brain is stuffed 
while the remaining organs of the body are starving. 



146 The Hygiene of the Schoolroom. 

Spurred on by teacher and parent, who see no Hmit to 
human endurance, the infant prodigy is developed and 
finally goes the way of all infant prodigies. 

Every physician knows that his family practice annually 
brings cases worn down by school work. The major 
share of the cases is found among the girls, who usually 
are more serious students than the boys, and do not enjoy 
the invigorating exercises of the latter. 

Dr. S. Weir Mitchell, than whom there is none better 
qualified to speak on this subject, says: "I believe that, 
as concerns the future of our women, they would do far 
better if they were more lightly taxed, and the school 
hours but three or four a day until they reached the age 
of seventeen. Ai.ything, indeed, would be better than the 
loss of health, and if it is a question of doubt, the school, 
unhesitatingly, should be abandoned or its hours greatly 
lessened, as it is at least in part the source of very many of 
the nervous maladies with which our women are 
troubled. 

"Overwork of the brain is a serious evil to women at the 
age of womanly development, when the nervous system is 
so sensitive and irritable, and at no other time is an 
abundant supply of fresh air and exercise so important. 
The American woman to-day is perhaps, of all civilized 
females, the least qualified to undertake the weighty tasks 



Modern Education and Health. 147 

which tax the nervous system of women. How few 
mothers are there to-day, in the higher educated class of 
women, who have rushed through college and played the 
devotee to fashion and society that can nurse their off- 
spring !" 

Dr. W. W. Potter, in his address as President of the 
Medical Society of the State of New York, said : "The 
years between ten and fourteen are full of import for a 
girl : during them she lays the foundation for future 
weal or woe, and I hesitate not to declare that this is a 
period of infinite responsibility for mothers, perhaps the 
greatest of any part of the educational life of their girls. 
Many girls begin their new physiological life at the age 
of twelve ; but, if they should not do so quite as early, this 
is still a period when nature is making preparations for a 
new existence for the young female, and if her plans are 
interfered with or thwarted, even in their smallest details, 
years — long, sorrowing years, perhaps — of pain and suf- 
fering and woe are sacrificed to the shrine of ignorance 
or wilful neglect. The scholastic training of girls is 
being carried on with its greatest vigor at the very time 
when they are physically least suited to bear the strain. 
Just when the ovary is beginning to require a large ex- 
penditure of nerve force, the brain, under our present 
system, is demanding all that an active cerebration can 
produce, and oftentimes even more. 



14^ The Hygiene of the Schoolroom. 

"I am heartily in favor of the higher education ot 

women, but am thoroughly opposed to the present system 
of female education. Too much is attempted in the time 
allowed in preparatory schools. It were far better to 
have fewer studies thoroughly comprehended, than to 
attempt to cram with a number that can only be super- 
ficially acquired in the time allotted to them. Notice 
some of the star pupils who have been 'prepared' for 
exhibition. That girl is a 'bright' scholar. She is a 
chronological almanac, and can tell every date in English 
history from Caesar's Invasion, or tell of all the battles 
the world has known and the number of the fallen; will 
tell you in an instant if one pipe empties a pond in seven 
hours and another in four, just how long it will take 
two to do it. She will lead you at a lively pace through 
the labyrinth of compound restrictive clauses with parrot- 
like precision, but it is simply mental discipline ; a simple, 
real, face-to-face problem will cause her to falter and 
stumble." 

The present generation, taking heed to the hundreds of 
physicians who have decried present educational methods 
and their physical results, is just beginning to show faint 
signs of improvement. But even yet there are too manv 
schools, both private and public, conducted along the 
same line as Dr. Blimber's school, described by Dickens in 
Dombey and Son. 



Modern Education and Health. ' 149 

"Dr. Blimber's establishment was a great hothouse in 
which there was a forcing apparatus constantly at work. 
Mental green peas were produced at Christmas, and intel- 
lectual asparagus all the year round. Nature was of no 
consequence at all ; no matter what a young gentleman 
was intended to bear, Dr. Blimber made him bear to order 
somehow or other. This was very pleasant and ingenious, 
but the system of forcing was attended with its usual 
disadvantages ; there was not a right taste about the pre- 
mature productions, and they didn't keep well. . . . 
And people did say that the doctor had rather overdone it 
with young Toots, who, when he had whiskers, left ofif 
having brains." 

Savage nations have always held education in small 
favor, finding by experience that tha school acted badly on 
the bodily health of their children. Dr. J. H. Kellogg, 
of Battle Creek, Michigan, cites an example of personal 
observation that emphasizes well this point : 

"Some years ago, while spending a short time among 
the Yuma Indians, in the vicinity of old Fort Yuma, Ari- 
zona, I observed one morning a considerable number of 
old warriors and chiefs gathering in from the forest and 
collecting in the old fort. Upon inquiring I found there 
was to be an Indian school-meeting, the first one ever 
held among the Yumas. 



150 The Hygiene of the Schoolroom. 

"The school had been started some two years before by 
Sister Alphonse and two or three other devoted Catholic 
sisters, who had ventured into the wilds of Arizona to 
undertake the experiment of educating the Yuma boys 
and girls ; but their school had not prospered. The chil- 
dren had been kindly treated ; they had been supplied with 
an abundance of food, whereas before they were often 
hungry ; they had been furnished with clothing, including 
hats, bonnets, shoes and stockings, whereas before they 
had roamed the forest in nakedness. The schools were 
furnished with all the necessary modern appliances and 
the teachers labored earnestly in behalf of the students. 

"Nevertheless, Sister Alphonse confessed to me that the 
school was not a success, and that the old Indians were 
very much opposed to it. I inquired the reason for their 
opposition, and was told that the Indians complained that 
going to school did not agree with the health of their 
children ; that after having been in school a few months 
they were far less robust and vigorous than before, and 
that they suffered from indigestion, catarrh, and other 
diseases, from which they were before as free as the 
birds, the antelopes, and the prairie dogs among which 
they lived. The good sisters honestly admitted that the 
complaint of the old Indians was not without foundation 
pnd that it was true that for some reason the little wild 



Modern Education and Health. 151 

children of the forest began to lose their vigor and 
vivacity soon after entering school, and therefore some of 
the most sagacious parents had kept their chidren at 
home. 

"The school meeting had been called for the purpose 
of presenting to the old Indians the advantages of an 
education, so as to convince them, if possible, that the 
children would better have an education even if the get- 
ting of it should spoil their stomachs, weaken their lungs, 
destroy their keen sense of smell through catarrh, impair 
their eyesight, dull their hearing, and deprive them of the 
hardihood which had enabled them for centuries to main- 
tain the independence which they still possessed. 

"I did not remain to hear the conclusion of the matter, 
but a few years later, in passing through the country on 
a visit to the Pacific Coast, I spent a day among 
the same Indians. I found the school flourishing, to 
the great delight of the good sisters, but the children 
perishing. Their forest air of rollicking freedom had dis- 
appeared, and the evidences of physical depression and 
deterioration were unmistakably apparent. Civilization 
had conquered, and the Indians had become convinced 
that their children must be educated even at the expense 
of health and vigor." 

With such undeniable proof of the unhealthy drift of 



152 The Hygiene of the Schoolroom. 

modern school methods, we should study to find the causes 
and remedies of the effects produced. 

School children are prone to suffer from anaemia, in- 
digestion, headache and neuralgia, insomnia, nervousness, 
chorea, and fatigue. Anaemia is a condition visible as 
a great pallor of the skin and weakness. It is the com- 
mon complaint when a child is spoken of as being "run 
down." It is usually persistent in its course, appearing 
most often in girls, and sometimes is the herald of a life- 
time of weakness and invalidism. Lack of exercise, too 
much confinement, and improper nourishment, are the 
commonest causes. Indigestion sometimes appears alone 
or accompanied by anaemia, and has usually the same 
causes. Headache and neuralgia claim many sufferers 
of school age, and are attributable to poorly ventilated 
rooms, over-study, eye-strain, and fatigue. Insomnia is 
most often noted among school children who worry es- 
pecially over keeping up the work, or about examination 
time, when the brain becomes over-taxed. 

Chorea, or St. Vitus Dance, is common in school life. 
It consists of irregular, involuntary contraction of mus- 
cles, sometimes with slight mental disturbances. At 
times the muscles of the face or neck, or the head itself, 
may twitch, producing horrible grimaces. It may be 
hereditary or be the result of exhaustive drains on the 



Modern Education and Health. I53 

nervous system from school work. Immediately, when 
this trouble is recognized, the child should be removed 
from school for his own sake, for the quiet it secures, and 
for the good of the remaining pupils. Careful observers 
have traced cases that were caused by children's imitating 
the movements of a real sufferer. The disease lasts in 
mild cases about ten weeks ; in others six months or more. 
The child should not be returned until after a physician 
has pronounced the disease entirely cured, as in numerous 
cases too early return to school is followed by relapse. 
When hysteria is encountered at school the victim should 
be placed in a quiet room and left absolutely alone. Sym- 
pathy or attention from those around serves only to in- 
tensify the attacks. 

Nervousness, the American national disease, is a hyper- 
excitability of the nerves, which shows itself in various 
forms. The m^ost prominent symptoms are twitching of 
muscles, convulsive movements, drowsiness, headache, ir- 
ritability, great restlessness, unexplainable fears, inde- 
cision, and inability to concentrate thought for any great 
period of time. In many cases it is hereditary, and in 
other cases acquired. If it be true that nervousness and 
its grown-up brother, nervous prostration, are so typically 
American, it would be national wisdom to find out how far 
they are caused by school work, and to attempt to cut them 



154 The Hygiene of the Schooh-oom. 

off ere they have driven their roots into the very ground- 
work of the child's constitution. To begin with, chil- 
dren are sent to school too young for serious study. The 
kindergarten should receive children from four to seven 
years old. At seven years of age, at least no earlier than 
six, the real primary work may commence with the 
normal child. But if a child be backward in development, 
either mental or physical, his entrance into school should 
be delayed. 

With children from six to ten years of age there should 
be two sessions of no greater length than an hour and a 
half each; from ten to fourteen, two sessions of one and 
three-quarters hours each ; and for the remainder in public 
schools, two sessions of two hours each. 

All medical men who have studied the school question 
hygienically have pronounced the school hours too long, 
and have proved that just as good results can be got 
from the plan of reduced hours as from the plan in prac- 
tice to-day — even better intellectual and indubitablv better 
physical results. 

"Mr. Charles Paget, formerly M. P. for Nottingham, 
England, once tried in the village school on his estate 
at Ruddington a very interesting experiment. He was 
not satisfied with the general progress made by the boys, 
and he provided for them a large garden. The school 



Modern Education and Health. 155 

was then divided into two similar sections, one of which 
was kept to the ordinary school work for the ordinary 
hours, the other for half of these hours only, the rest 
of the school time being devoted to work in the garden. 
At the end of the term the half-time, or gardening, boys 
had excelled the others in every respect ; in conduct, in 
diligence, and in the results of study." 

This illustration is not overdrawn, nor at all hard to 
explain. A similar experiment was tried in this country 
in a school in which the girls at first excelled the boys. 
The boys were set free to play during one-half the former 
school hours. The result was that the boy's soon over- 
took and excelled the girls. 

If, then, better work is obtainable in half the time, 
where is the wisdom of such long hours ? Bu^:, the answer 
comes, we have the schools and the teachers at our service, 
and in many cases the mother is glad for the time being 
to have the child cared for and her own burdens made 
lighter. All true enough, but too little reason for the 
child's confinement when health is in danger. 

In communities where great crowding is the rule, and 
schools are opened in basements and every other available 
space, it would be far wiser to have relays of pupils in 
the regular school buildings. For instance, just as good 
results would be accomplished by having the first division 



156 The Hygiene of the Schoolroom. 

come to school at 9 a. m., remain until 10.30 a. m.^ and be 
dismissed. At the latter hour school would then begin 
for the second division and continue until 12 m. At 
1.30 p. M., the first division would reassemble and work 
until 3 P. M._, when the last session of the second division 
would begin, lasting until 4 p. m. In this manner double 
the ordinary number could be housed and under better 
conditions than temporary quarters could provide. 

The assignment of work to pupils, it is hoped, will some 
day be radically changed. As a measure of economy, the 
ordinary school is now divided into two or more classes. 
The pupils of each class, without regard to their capacity, 
are supposed to keep up with the work of their fellow 
pupils. It is true that the allotment of special work to 
each individual child would multiply the work of the 
teacher ; yet this plan deserves serious consideration. In 
industrial life it has always proved impossible for a num- 
ber of men to accomplish equal aniounts of "piece work" 
unless the required amount is a very low one, so low as 
to be far below the ability of a great many. The same is 
true in school work. If an amount of work is allotted 
sufficient for the dull ones, it will be a too easy task for 
the brighter ones. The standard of work is therefore 
set high, and many are dragged along, doing more than 
their brain power should allow, and actually suffering 



Modern Education and Health. 157 

from the study imposed. Ideal conditions will only be 
found when the right measure of a child's capacity can 
be found and the required work can be made com- 
mensurate with it. 

In America to-day all roads lead to specialization : the 
old-time general education, which was a conglomerate 
cramming, an educational potpourri, is fast giving away 
to specialties. The high schools and the colleges all have 
courses leading to definite departments of life without 
taking on the many useless frills. So, also, the work in 
the lower schools should be shorn of all that is useless. 
It is better that proficiency be attained in a few studies 
than to have a smattering of all. 

Home study should be recommended only when abso- 
lutely necessary, and if the child's physique is below par, 
not at all. For children below the age of twelve, the 
hours at school, if used to the best purpose, take all of the 
time in which the brain should be used, and the additional 
home work, which is most often done at night, and by 
artificial light, destroys much of the bodily energy which 
could be used more advantageously. The same is true of 
the "extras," such as music, painting, and needlework. 
Many a growing girl is unable to stand the double strain 
of arduous school duties followed by hours of practice in 
accomplishments forced upon her by proud parents. The 



158 The Hygiene of the Schoolroom. 

parent is the true arbiter of the question, and if the "ac- 
compHshments" must be had, the time allotted for them 
should not be so great as to interfere with the regular 
school work. Dr. Halle of Berlin states that out of every 
one thousand young girls who begin to learn the piano 
before they are fourteen, six hundred are affected by 
some kind of nervous disease, while out of one thousand 
other girls who are not taught the piano only one hun- 
dred sufifer in a like manner. The doctor recommends 
that the study of the piano should not begin until after 
the age of sixteen. 

It is not proper treatment to keep a dull child after 
school for inefificiency. He may be one who has tried 
hard and is unable to come up to the standard. To keep 
him after school will surely make him duller. The 
school course should be a flexible one, and no tasks 
should be given to any pupil which he cannot accomplish 
during ordinary school hours. 

Many pupils are able to keep up with their classes by 
dint of hard work, but find when examination time comes 
that the extra labor incident to review is too great. Then 
they succumb. More pupils sufifer from headache, 
fatigue, and nervousness, at the time of, and after exam- 
ination, than at any other period of the school year. For 
this reason many are now wisely pleading for the abolition 



Modern Education and Health. I59 

of completive examination as being useless and as expos- 
ing the pupil to physical harm. This reform could be 
carried through without loss to school work. 

All of the many enumerated causes, either singly or 
combined, lower the force of the nervous and muscular 
system : the brain power is at a low ebb and physical 
strength also suffers. This is the state spoken of as 
fatigue. In this condition the child has not one-tenth 
of his normal power, his ability to concentrate is poor, 
and his retention is almost nil. In such cases a long pe- 
riod of rest from the school is advised. With milder 
cases, a lessening of the work, with opportunities for 
physical building up, will suffice. 

The lessons should be short; when long, there should 
be pauses between. Best attention in school can be had 
during the opening hour of the morning, as the child's 
mind is then in best condition for work. Too often this 
valuable hour, which should be devoted to the most diffi- 
cult studies, is given to miscellaneous exercises, interest- 
ing, it is true, but better adapted to a later hour in the 
morning, when fatigue has already made itself apparent. 
The best hours for school work are from 8 to 10.15 
A M. ; the worst hour is from 11 to 12. From i to 2.30 
p. M. is the third best, and from 3 to 4 the second best. 
Kemsies says the studies he found to be most fatiguing in 
order were : gymnastics, mathematics, foreign languages, 
religion, mother tongue, natural history, geography, his- 



i6o The Hygiene of the Schoolroom. 

tory, singing, and drawing. In Paris, at the L3cee, the 
Minister of Education allowed a teacher to change the 
order of the work to accord more with his idea of the 
pupil's ability, and found that the work that usually re- 
quired seven years was as well done in three and one- 
half. Lastly, the greatest enemy to fatigue was the old- 
fashioned recess, where the children were allowed ten or 
fifteen minutes of play. Teachers cor-^plained that this 
recess got the pupil's mind ofif the work. This is the 
simplest and best argument in its favor. 

In order to present a clear mind for school work in the 
morning, it is very essential that a child have the requisite 
amount of sleep for one of his age. 

The average amount of sleep required at 
4 years old is 12 hours, 

y « U .. jj U 

9 " " " loy. " 
12-14 " " " 9-10" 
14-21 " " " 9 '• 

It will be difficult to attain to the ideal at once, but ad- 
herence to these suggestions wi'll go a long way towards 
giving better bodies to our school children, probably with 
no loss to the mental faculties. It is useless to store a 
beautiful mind in an unhealthy body. The real education 
is a healthy combination of good mind and good body, 
for, as Paley says, "It is ever}- preparation that is made 
in our youth for the sequel of our lives." 



CHAPTER XIII 
School Diet 

The subject matter of the present chapter has greater 
interest for boarding schools than for public schools. In 
the latter, however, it should be a subject for investigation 
by the teacher, that she may be able to instruct the pupils 
as to what foods and what quantities are most suitable 
during school life, when physical and mental growth are 
most exacting in their demands. 

Parents, ordinarily, manifest little concern in the diet 
of the child, offering the same foods to one of tender age 
as are offered to the robust workingman. The excuse in 
many cases is that with moderate means it is well-nigh 
impossible to present a great variety, and economy forces 
all the members of the family to partake of the same 
eatables. Fortunately, this is false reasoning, for it is 
the truth that the most nutritious foods are those of least 
cost. Adv^ocates of particular dietary fads, such as ex- 
clusively vegetable food, are not to be heeded, for experi- 
ence has taught that with the school child a wise variety 
combining proper admixture of animal and vegetable 



1 62 The Hygiene of the Schoolroom. 

food is the most desirable. The proportion of meat at 
all meals for children should be small, preference being 
given to the so-called physiological food for children, 
cereals, vegetables and milk. Many parents of means 
are ignorant of these matters, and short talks by the 
teacher to the pupil will be productive of great good. 

Many diseases are traceable to faulty diet. The system 
becomes debilitated because the food taken does not 
supply vital power enough to blood, bone and muscle. 
Disease setting in with such patients finds especially easy 
prey. Of one thousand pupils examined surely forty 
per cent, were really ill-nourished. Their pale, drawn 
faces and thin bodies told the tale, and carrying the in- 
vestigation still further into the homes, many times it 
was found that the child was a voracious eater, but always 
fondest of just such food? as did not add to his mind or 
his muscle. 

Children should rise from bed in the morning in suffi- 
cient time to eat their meals slowly, and not have to 
bolt a hasty breakfast. The habit of deliberate eating 
should be cultivated in youth. Food taken into the 
mouth in large portions and only partially mixed with the 
saliva gives the stomach three times the ordinary work. 
Soon this organ rebels and will be unable to digest food 
even if properly taken. Breakfast and supper should each 



School Diet. 163 

consume at least one half-hour's time, and the dinner 
three-quarters of an hour. 

Young children from seven to fifteen years of age may 
find it too long a time to wait for food during the long 
sessions of the school. In such cases the parents should 
send a lunch to be eaten at a definite hour rather than 
sweets or fruit that will be nibbled at from time to time. 
Strange as it may appear breakfast is the meal most 
difficult to provide for the pupil. Often the anxious 
parent brings the child to the physician with the story that 
it is impossible even to force the child to eat upon rising 
from bed, and that day after day he goes to school with 
an empty stomach. Long before noon the child is weak 
and has a violent headache. Often this loss of morning 
appetite is due to sleeping in a poorly ventilated room, 
or, perhaps, to too late hours. The best remedy lies in 
providing pleuty of fresh air in the sleeping room and 
in sending the child to bed in time to get sufficient sleep 
by early morning, when an hour can be taken for a walk 
or some exercise before breakfast. 

The breakfast meal should consist of cei'eals, eggs o? 
fish, bread and butter, fruit, milk or cocoa. If the tea 01 
coffee habit is already formed, the drink should be served 
very weak, principally hot water or milk. But it i^s better 
for children to avoid tea and coffee altogether, as there is 



164 The Hygiene of the Schoolroom. 

no good derived from them, and their injudicious use 
often leads to such ailments as nervousness, indigestion, 
and constipation. It were better if meat were not 
served for the morning meal. The dinner should be at 
mid-day, and should comprise soups, meat, potatoes, and 
other vegetables, with some pudding, pastry, and fruit. 
The best meats for children are roast beef, beef steak, 
roast lamb, mutton, chicken, and bacon. Pork and veal 
are not suitable. Supper, to ensure a good night's sleep, 
should be an easily digested meal. Porridge or rice, with 
milk or cream, bread and butter with preserves, some light 
pastry and hot milk, with but small portions of meat and 
vegetables, are most serviceable. Many refuse to give 
meat and vegetables for this meal, but they may be eaten 
without harm by those over twelve years of age. 

Alcohol should not be given in any form to children. 
Setting aside the moral question, from a physical stand- 
point the use of alcohol works only harm upon the child. 
It retards growth and induces nervousness and irritability. 
These words are intended as a warning to those among 
the poorer classes who serve beer to their children with the 
idea that it is good for them and will help their appetite. 
The belief that alcohol in any form is an essential part 
of a healthy diet or that it contains any considerable food 
value is no longer held by scientists whose opinion is of 
Sfreatest value. 



School Diet. 165 

The Committee of Fifty, who gave closest inquiry into 
the alcohol question in 1902, reported: 

"We believe that the occasional or moderate use is 
most likely to be harmful to young persons, and mainly 
because of the danger of leading to excess." 

"They are not needed by young and healthy persons 
and are dangerous to them in so far as they tend to cre- 
ate a habit." 

"They are useless as preventives of infectious or con- 
tagious diseases. On the contrary they appear to lessen 
the power of the organism to resist the effects of the 
cause of such disease." 

If the beverage is not offered to children they do 
not desire it. Milk is cheaper and is incomparably 
better for them. There can be no excuse, then, 
for the use of alcohol, unless prescribed by a phy- 
sician. In some of the debilitating diseases, in chil- 
dren suffering from anaemia and inherited consumption, 
it is sometimes prescribed in the form of a light wine, but 
its use should always be guarded. Milk is nature's ideal 
food, and a child's home education is neglected if he is 
not taught to drink it with pleasure. It should form a 
large part of the child's diet, be given at each meal, and 
even at night should a child wake up hungry. To per- 
sons who are charitably inclined and ever ready to help 
the poor, we suggest that it would be an excellent idea 



i66 The Hygiene of the Schoolroom. 

to establish a fund for supplying a daily lunch of milk 
and crackers to the children in some of the schools whose 
ranks are filled mostly from the poorer people. A 
glance into these schools shows numbers of poorly nour- 
ished little ones who would be greatly benefited by a 
light lunch in the middle of the morning and the after- 
noon session. * 

Fruit makes healthful food for the young, and they 
should be given a bountiful share of.it with their meals. 
Sweets, meaning thereby candies, would serve a good 
purpose in supplying a needed part of the sugar to the 
system, were it not a fact that so much is ordinarily taken 
as to destroy the appetite for the usual meals. Confec- 
tionery should never be a part of the school lunch : the 
same applies to pickles, a favorite relish which satisfies 
in some a craving for something bitter, but is of no use 
as a food. 

For school diet, then, nutritious foods are to be used, 
the meals s;hould be regular, the articles of food thor- 
oughly masticate^ and slowly swallowed. The child 
should be taught to eat those articles known to be nu- 
tritious, even though he dislikes them at first. With a 
little patience, in the same manner that he can be taught 
to overcome any other repugnance, a child can be taught 
to eat and enjoy the foods known to be best for his par- 
ticular period of growth. 



CHAPTER XIV 

Physical Training and Exercise 

It is important that the school in exacting from the 
pupil five hours of daily concentration upon study should 
plan periods during the day when the mind can be rested 
and when pleasing, helpful exercises of the body be sub- 
stituted for mental drill. This relaxation can be sought 
in any form of physical exercise desired, whether in reg- 
ular studied calisthenics or in unrestrained play. Phy- 
sical training will give the same power and control to the 
muscles that mental training gives to the mind. 

Calisthenics should be as compulsory as any other work 
unless a child presents a certificate from a physician to 
the effect that the particular child has something in his 
physical make-up which forbids this work ; but because 
a child is weak and delicate is no reason why the gym- 
nastic work should be entirely prohibited. Such cases 
demand intelligent treatment, and necessitate a lessening; 
in the period of time spent rather than an entire abandon- 
ment. It is important, then, that some study should be 
given to the question of the exercise most suitable to age 



i68 The Hygiene of the Schooh'oom. 

and sex, the proper time, and the amount of time to be 
consumed. 

The caHsthenics are best given during the first period 
of school work and should not take over fifteen mmutes. 
By investigating it has been found that the exercises as 
carried out under the instruction of a physical director 
are very fatiguing if kept up longer than fifteen minutes. 
The principal reason for this is that the work is too se- 
rious and studied and the child takes it as a task rather 
than a recreation. Some very careful and observing ed- 
ucators have of late years recommended for the lower 
grades short periods of play at intervals during the school 
hours, with real games, which please and spur the child 
on, giving the desired relaxation from mental work. 

The particular exercises given to the young are treated 
in books devoted to this special subject, but in general it 
is proper to insist that much of the work should tend to 
make the child stand erect, walk properly, and breathe 
well. Respiratory gymnastics can be taught in the school 
and the practice taken at any time ; the training should 
teach that proper respiration consists not in quick, sud- 
den gasps, but in taking deliberate long breaths that give 
extensive expansion to the chest. So important is the 
breathing capacity considered that all insurance com- 
panies in their medical examinations ask to know the 



Physical Training and Exercise. 169 

amount the chest expands from a deep exhalation to a 
deep inhalation. Further, it is a well known fact that 
people who continually breathe through the nose are less 
liable to infectious diseases and pulmonary complaints, 
and that those who sleep with the mouth closed never 
awake with the painful and disagreeable sensation of 
parched throat and cracked lips. It is impossible, how- 
ever, in such a work as this to go over all the different 
exercises practised in physical training. These few 
points about respiratory gymnastics are mentioned only 
to call attention to the importance of the subject. Cer- 
tain occupations, certain games, tend to develop certain 
sets of muscles; physical training benefits all muscles. 

As a matter of economy, in a number of communities 
attempts have been made to have this line of work done 
by the regular teacher, who in turn was supposed to have 
received some training in the methods of physical exer- 
cise. This plan has always proved to be unwise; the 
work is never carried out as well or with such interest 
as when directed by a physical instructor. 

Athletics in some form or other may be commenced 
about the twelfth year. If in the school gymnasium, they 
should be under the trained eye of some c[ualified person, 
as there is great danger of young children's over-exert- 
ing themselves in trying to do the same feats as their fel- 



lyo The Hygiene of the Schoolroom. 

lows. In the gymnasium two half-hour periods, one in 
each session, are sufficient. Dr. Sargent urges that no 
violent exercise be taken until three hours after a meal. 

The outdoor play is not so easily regulated as the in- 
door, but the pupils should be taught that no exercise 
is beneficial which is carried beyond the point of bodily 
fatigue. Horseback riding and bicycle riding are invigo- 
rating and healthful exercises. The wheel, however, 
should be used in moderation. The mooted question as to 
whether wheeling is a healthful exercise for girls is gen- 
erally settled in its favor, if only the girls use some dis- 
cretion and avoid long, violent rides and riding at the 
menstrual period. The chief trouble with boys who ride 
a wheel, is in getting them to ride in an upright position, 
their desire to be racers inducing them to assume a 
stooped position which is anything but beneficial. The 
principal exercises suitable for girls are golf, lawn tennis, 
swimming, fencing, and basket-ball. All are sufficiently 
exhilarating to be enjoyed and do not require the great 
endurance that some of the more rugged sports do. 
Baseball, football, rowing, boxing, wrestling, bowling, 
swimming, and running are the exercises that best please 
the boys. All should be learned and practised. Some 
have a good influence on one set of muscles, while others 
hdp the lungs, heart, and stomach. 



Physical Training and Exercise. 171 

Every teacher should interest himself or herself in out- 
door sports and remember that the ideal pupil is the one 
that leaves the school with a strong mind to battle with 
the world and a strong body to carry that mind about in. 
There are too many children who are encouraged to 
spend their spare time at school and at home always with 
books that they may excel in their studies, and yet who 
are easily distanced later in the real school of life by their 
less intellectual but more sturdy fellows. 



CHAPTER XV 
Corporal Punishment ' 

It is but a few years since the practice of corporal pun- 
ishment was very general. Severe punishments and flog- 
gings were often resorted to, even to such an extent as to 
physically disable the pupil for a few days at the time. 
Schools in certain districts engaged their teachers upon 
muscular qualifications rather than mental. Thrashing 
was thought to be an essential to education, and if a pupil 
did not or would not learn the lessons, he had them 
"knocked into him." It is pleasing to note, however, 
that with the great improvement in all educational mat- 
ters this practice has almost entirely disappeared. To- 
day better discipline is maintained in just such schools by 
young "school-ma'ams" who never wield the birch but 
have been carefully trained in properly handling school 
children. To-day the best teachers are those who find 
least need to resort to corporal punishment. 

But there still goes on a discussion as to the necessity 
at any time of corporal punishment, by which we mean 
some pain or suffering inflicted upon the body of the pu- 



Corporal Punishment. 173 

pil for some offence against the school law. Many who 
have gladly seen its use lessened to a minimum contend 
very strongly that there still is a use for guarded corporal 
punishment in the schoolroom and that there are cases 
which cannot be successfully treated by other means. 
And there are undoubtedly some few, the bullies usually, 
who sneer at moral suasion and any corrections other 
than corporal punishment. 

On the other hand there are those who insist upon the 
entire abolition of corporal punishment in schools, hold- 
ing that it is never of any use as a corrective measure; 
that wherever allowed, it is abused ; and that it is an end- 
less source of trouble between teacher and parent. It is 
probable that the truth lies half-way between, — that in 
the great majority of cases other means should be re- 
sorted to, but that doubtless there are cases where, with- 
out the use of corporal punishment, no impression what- 
soever can be made. 

Rollin, the French historian so well known • from his 
Ancient History, early in the i8th century wrote a "Treat- 
ise on Studies," in which he has well-defined views on the 
subject under consideration. The following are a few 
extracts : 

"i. The first duty of the teacher is to study well the 
genius and character of children. To wish to place them 



174 The Hygiene of the Schoolroom. 

on the same level, and to subject them to a single rule, 
is to force nature. 

"2. In education the highest skill consists in knowing 
how to unite, by a wise temperament, a force that re- 
strains children without repelling them, and a gentleness 
that wins without enervating them. 

"3. The short and common method of correcting 
children is with the rod ; but this remedy sometimes be- 
comes a more dangerous evil than those which one seeks 
to cure, if it is employed without reason and moderation, 

"4. The only vice, it seems to me, that deserves se- 
vere treatment is obstinacy in evil, but an obstinacy vol- 
untary, determined, and well defined. 

"5. The teacher ought never to punish in anger, 
especially if the fault which he punishes concerns him 
personally, such as a want of respect or some offensive 
speech. 

"6. CufTs, blows, and other like treatment, are abso- 
lutely forbidden to teachers. They ought to punish only 
to correct, and passion does not correct. 

"7. It is a quite common fault to make use of repri- 
mands for the slightest faults which are almost inevitable 
to children. This breaks the force of reprimands and 
renders them fruitless. 



Corporal Punishment. I75 

"8. We should avoid exciting the spite of children by 
the harshness of our language, their anger by exaggera- 
tion, their pride by marks of contempt. 

"g. It is necessary always to show children a substan- 
tial and agreeable end which may hold them to work, and 
never pretend to force them by a direct and absolute au- 
thority. 

"lo. We should run the risk of discouraging child- 
ren if we never praised them when they do well. Al- 
though praises are to be feared because of vanity, it is 
necessary to make use of them to encourage children, 
without cultivating that vice. 

"ii. Rewards are not to be neglected for children, 
and although they are not, any more than praise, the 
principal motive to make them act, yet both may become 
useful to virtue, and a strong incentive to its practice." 

Horace Mann, in his "Lectures on Education," in re- 
ference to this subject says: "Yet great as the evil is, 
I admit that it is less than the evil of insubordination or 
disobedience. It is better, therefore, to tolerate punish- 
ment, in cases where the teacher has no other resource, 
than to suffer insubordination or disobedience in our 
schools. Yet how infinitely better to secure order and 
proficiency by the power of conscience and the love of 
knowledge — to supersede the necessity of violence by 



176 The Hygiene of the Schoolroom. 

moral means. This is already done in a considerable 
number of schools ; I trust it is done, with regard to some 
scholars, in every school ; that is, I trust there are at least 
some scholars, in every school in the Commonwealth, who 
never know the degradation of the lash. I trust there is 
no teacher with such a vacuum of good qualities and 
such a plenum of bad ones, as to create the necessity for 
indiscriminate and universal flogging. What, then, ought 
teachers to do? I answer, they should aim to reach 
those higher and higher points of qualification, which 
shall enable them to dispense more and more with 
the necessity of punishment. If there is any teacher 
so low in the scale of fitness or competency as to feel 
obliged to punish every day, he should strive to prolong 
the interval to once a week. If any teacher punishes but 
once a quarter, he should strive to punish but once a 
year." 

Editorially speaking on this subject, the A'czu York 
Medical Record says, "The question of corporal punish- 
ment in schools has been much discussed lately in Ger- 
many and Switzerland, and the Canton Berne has come 
to a decision in the matter. The Ethical World considers 
the new law a compromise between the flagellants and the 
anti-flagellants. It prescribes the use of the cane for 
grave faults such as indicate moral perversion ; repeated 



Corporal Punishment I77 

lying is given as an instance, and it is expressly forbid- 
den to punish for want of application. Girls are not to 
be punished physically at all." 

Certain forms of punishment are never to be tolerated, 
such as pulling or boxing of the ears. Serious damage 
has time and time again been done by teachers who, in 
their haste, have inflicted punishment in this manner. 
Slaps or blows upon the head likewise cause at times 
grave discomforts which persist for some time, such as 
dizziness and headache. It is well to remember, as Dr. 
Bristowe says, that there are some parts of the body that 
seem to be made for chastisement ; and he speaks of the 
"posterior aspect of the human form divine." There is 
nothing so demoralizing to discipline as for a teacher to 
strike such a blow in anger and then spend the following 
hour in coddling back the same child to good nature. 
If corporal punishment is to be inflicted, it should not be 
done at the time of the offense, but later, when all traces 
of anger that might have existed shall have passed away. 

Keeping in at recess and after school is not a right 
means of punishment, as all agree that the school hours 
are sufficiently long and fatiguing. Such tasks as stand- 
ing for long periods should not be imposed on growing 
children, as long continued standing conduces to stooped 
shoulders and curvatures of the spine. Committing to 



178 The Hygiene of the Schoolroom. 

memory or writing long extracts accomplish but little in 
a corrective way. The most satisfactory means of cor- 
rection with many pupils will not be in imposing difficult 
tasks at the expense of bodily energy, but the deprivation 
of certain privileges and pleasures that are accorded their 
better-behaved fellows. 

Before punishing for want of application the teacher 
must satisfy herself of two things : first, that the task be 
not greater than the ability ; and secondly, that there is 
no bodily defect which unfits the pupil for school work, 
such as defects of eyes or ears, or any abnormalities, 
such as adenoid g^rowths in the throat. 



CHAPTER XVI 
Sickness and Accident in the Schoolroom 

In considering ideal conditions in the schoolroom that 
tend to the prevention of sickness and accident, it is but 
a step away to dwell for a moment on what is first to be 
thought of when such complications arise in school. It 
is a wise thing for a teacher to know what to do and what 
not to do, — to know her own real limitations. 

Ordinarily if "a, little knowledge is a dangerous thing," 
then a little knowledge of medicine and surgery is doubly 
dangerous ; but in the government of hundreds of chil- 
dren gathered under one roof and engaged at times in 
rough games, accidents are sure to occur and the teacher 
is always the first one to look to in such emergencies. 
The same applies with equal force to the minor ailments 
of children during the school hours. 

With sickness the teacher may use such natural means 
as her knowledge directs, like applications of hot or cold 
water, vigorous rubbing, recumbent posture, or removal 
to a quiet room, but she should never use medicines with 
any of the pupils. The giving of medicine is entirely be- 



i8o The Hygiene of the Schoolroom. 

yond her province, and though always done with good in- 
tent may sometimes lead to unpleasant complications. 
Reference is made principally to the use of headache pills, 
powders, or capsules which are in such common use, yet 
all of which contain dangerous drugs. 

Headache may be treated by removal from the main 
room, which is often apt to be overcharged with impure 
air, and by applications to the forehead of cold water, 
and of smelling-salts to the nostrils, with dismissal if the 
pain persists over a half-hour. Injury to the eyes may be 
the cause of constantly recurring headache ; often chang- 
ing the seat to give more favorable light will be of benefit. 

With toothache and earache it is not wise to use any- 
thing but applications of hot cloths externally. If this 
means be not successful, other means of relief should be 
sought outside the schoolroom. 

Fainting is a common occurrence in schools, but usually 
is of only momentary importance. A child who has 
fainted should be immediately taken from the presence of 
the other pupils and laid down with the feet several inches 
higher than the head. The clothing should be loosened 
and the face and hands bathed in cold water. Within 
five minutes there should be some signs of returning con- 
sciousness, shown by muscular movements and return 
of blood to the face. 



Sickness and Accident in the Schoolroom. i8i 

Fits or convulsions are less remediable, occupying a 
regular interval and being little influenced by outside 
treatment. They are usually a form of epilepsy, most 
often what is called ''petit mal" and when encountered 
at school should be treated like fainting spells. What- 
ever measures are resorted to will do little beyond serv- 
ing the useful purpose of keeping those about employed 
in doing something. With many cases of epilepsy it is 
not advisable to send the patient to school at all, as attacks 
then occur with greater frequency; but numerous cases 
just on the border line where the spells are infrequent 
and mild are found, that do well at school. 

Attacks of hysteria, such as immoderate laughing or 
crying without cause, are difficult to handle. They require 
a firm will to combat their display and never should be 
given any coddling or petting. 

When one i's sunstruck or overcome with the heat it is 
advisable to secure as speedily as possible a physician's 
services. In the meantime, the patient should be removed 
to a shady spot, the clothing loosened, and applications of 
cold water and cold cloths made. 

In cases of frost-bite, which usually affects the ears, 
hands, or feet, the affected portion should be vigorously 
rubbed with snow or ice water and heat should be applied 
only very gradually. 



1 82 The Hygiene of the Schoolroom. 

For accidents it would be wise for a teacher to keep on 
hand such articles as a few bandages, some absorbent 
gauze and cotton, vaseline, and a solution of carbolic acid, 
one part to lOO of water. Many minor accidents could 
be looked after easily with such dressing at hand. A 
teacher should be everything to the child at school that 
the mother is at home. 

Bruises and many cuts, if they seem to be of no depth 
or importance, can be bandaged at the time of accident. 
The immediate bandaging of bruises about the head will 
give relief and prevent future swelling. 

A dog bite should at first be thoroughly cleansed, and 
then cauterized by a surgeon. 

Burns, unless of a very minor degree, should be treated 
by a surgeon after a preliminary application of vaseline 
has been made. 

Nosebleed is best overcome by placing the patient in a 
sitting posture, and applying pressure to both nostrils 
without any effort at blowing. If persistent, there are a 
number of other means to be used. Raise the arms 
above the head, apply ice to the nostrils and to the back 
of the neck, immerse the lower limbs in hot water to the 
knees or bandage them. Hot water or ice may be intro- 
duced into the nostrils. Should the use of these expedi- 
ents not suffice more skillful treatment may be required. 



Sickness and Accident in the Schoolroom. 183 

Hemorrhage from any bleeding vessel is best controlled 
by applying a compress of a folded towel, preferably 
soaked in hot water, to the affected part. If one of the 
larger vessels of the limbs is severed, more heroic treat- 
ment is necessary. Then the first thing to do is to get at 
the source. If necessary cut the clothing away and apply 
compression by means of a tourniquet, which ma^ be 
quickly improvised by tying a handkerchief or bandage 
about the leg above the injury, inserting a stick between 
the handkerchief and limb and twisting the stick about 
until the bleeding stops. Sometimes where the hemor- 
rhage is from a vein, the bleeding continues until a 
tourniquet is applied to the distal side of the wound. 

Where a limb is injured and a f-acture, dislocation, or 
sprain is suspected, put the limb to rest by attaching it to 
some form of a splint and send for surgical aid. Do not 
allow the limb to be pulled or manipulated in any way, 
as it will do no good and cause great pain. 

When foreign bodies, such as bits of dirt and cinders, 
get into the eye, forbid the child to rub it. Attempt to 
cleanse the eye with cold water holding the two lids 
separated with thumb and forefinger; or the sub- 
stance may be removed by drawing the upper lid down 
over the lower lid. If one is skillful enough, the upper 
lid may be rolled over a pencil and search easily made for 



184 The Hygiene of the Schoolroom. 

the offending substance, which may then be removed with 
a clean silk handkerchief. 

Foreign bodies in the ear are only to be removed by 
syringing with warm water. Sometimes flies and other 
insects crawl into the ear, causing great buzzing and dis- 
comfort. In such cases, if a lighted candle or lamp is 
held at the ear the insect will usually see the light and 
come out. When this fails, a few drops of warm olive oil 
or glycerine dropped into the ear will suffice. 

Where a school is in the vicinity of a river, as is often 
the case, drowning accidents are by no means uncommon. 
Whenever a person is removed from the water in an un- 
conscious and asphyxiated state, quick action is needed. 
It is impossible to have a number of rules at the finger 
ends to use, but a careful perusal of the following method, 
known as Sylvester's method of treatment of asphyxia 
from drowning, gives general ideas which should not be 
forgotten : 

Remove from the mouth and nostrils all obstructions 
to the free passage of air to the lungs ; free the body from 
any clothing that binds the neck, chest or waist ; turn the 
body over upon the face for a moment, thrusting a finger 
into the mouth and sweeping it round, to bring away 
anything that may have accumulated there. Then 
lay the body flat on the back, with something a few 
inches high under the shoulders, so as to cause the neck 



Sickness and Accident in the Schoolroom. 185 

to be stretched out and the chin to be carried from the 
chest. Draw the tongue well forward out of the mouth 
and let it be held by an assistant. (If there be no one 
present, a pencil or small stick may be thrust across the 
mouth on top of the tongue and behind the last teeth, to 
keep the mouth open and the tongue out of the throat.) 
Place yourself on your knees behind the head, seize both 
arms near the elbows and sweep them round horizontally, 
away from the body and over the head, till they meet 
above it; give a good, strong pull, and repeat every few 
seconds. After this, return the arms to their former posi- 
tion alongside the chest, and make strong pressure against 
the lower ribs, so as to drive the air out of the chest and 
effect an act of expiration. This need occupy but a sec- 
ond of time. 

This plan regularly carried out, will make about sixteen 
complete acts of respiration in a minute. It should be 
kept up for a long time, and not abandoned until the 
heart has ceased to beat. It should be remembered that 
cessation of the pulse at the wrists amounts to nothing 
as a sign of death ; and life is present when only a most 
acute ear can detect the sound of the heart. In a moder- 
ately thin person, deep pressure with the finger-ends just 
below the lower end of the breastbone may sometimes re- 
veal pulsation in the aorta when it cannot be found any- 
where else. 



CHAPTER XVII 
The Teacher's Health 

As the teacher hves in the same atmosphere as the child 
ckiring school hours, what is beneficial to one is equally 
so to the other ; but in many respects conditions are vastly 
different. The bad air, the poor light, and the oppressive 
heat are felt by both, but with the teacher there is the ad- 
ditional sense of responsibility and a continuous and 
wearing nervous strain. 

The advent of specialization in school work divides the 
responsibility somewhat, but nevertheless the teacher 
must needs be a paragon of all virtues. She must be 
strong and of good disposition. If not strong and often 
ill, the school work suffers from the numerous changes in 
teaching and governing. If the teacher be nervous or ir- 
ritable, she will do harm to the dispositions of the chil- 
dren by keeping them in a continual state of anxiety. A 
physical examination should be demanded of every appli- 
cant for a teacher's position. The following are impor- 
tant points: 

I. There should be no physical defect, such as curva- 
ture of the spine. One so affected, howsoever qualified 



The Teacher's Health. 187 

mentally, is not a desirable candidate. Her physical 
stren^h would naturally be below par and the effect of 
such a deformity upon young children would not be good. 

II. The heart and lungs should be normal and free 
from organic disease. This is essential for good bodily 
strength which will be needed to keep the school work 
up to the standard. A sickly teacher is a listless teacher. 

III. The eyes and ears should be examined for de- 
fectiveness. Faults in the eyes can in most cases be easily 
corrected by proper glasses, but a fault in the ears is more 
serious. If existing to any great degree it should be a 
permanent bar to an applicant's appointment. 

IV. A good speaking voice is needed in order that the 
instruction may easily be heard in all parts of the school- 
room. A high pitched, harsh voice grates unpleasantly 
on the children's nerves. 

V. There should be a general summing up of the en- 
tire system, just as the medical examiner of a life insur- 
ance company decides whether an applicant for a policy 
is a good risk. If there be lowered vitality in any re- 
spect, if the applicant would prove to be a p6or risk for 
an insurance company to assume, she will prove to be a 
poorer risk for the school board. 

VI. A careful study should be made of the applicant's 
disposition, in order to weed out all victims of the great 
American disease of "nerves," whether sufferers from 



1 88 The Hygiene of the Schoolroom. 

simple nervousness and irritability or from the more pro- 
nounced form of nervous exhaustion. 

A teacher who finds herself unable to restrain her ner- 
vousness and irritability should be conscientious enough 
to seek another occupation, as this is proof positive that 
she has not the requisite qualifications to preside over 
children. 

The most common affections among school-teachers 
are nervous diseases, dyspepsia, anaemia, and tuberculosis. 
The medical inspector should be empowered to examine 
all teachers yearly and to exclude from school work any 
suffering from tuberculosis. The teacher, more fortunate 
than many people in other walks of life, has a considerable 
space of time at her disposal. A portion of this time, — 
at least an hour — 'should be daily spent in exercise. This 
is the great remedy for the common condition of "nerve 
tire." No medicines will so efifectually wipe away this 
feeling of exhaustion as a romp through fields and woods, 
a spin upon the wheel, a game of golf in the summer, or 
an hour's indoor gymnasium work in the winter. Let the 
school teacher remember that as the nervous force is m 
such constant demand it should be conserved in every 
possible manner. When symptoms of fatigue and nerve 
strain are felt, avoid the use of such medicines as nerve 
tonics, which will in the end do only harm, and seek relief 
in exercise or periods of rest. 



The Teacher's Health. 189 

It is wrong, however, for the teacher to become imbued 
with the idea that hers is the most exhausting and Jife- 
destroying occupation known. Some writers of late have 
dilated upon this idea and one superintendent of schools 
goes so far as to say that five years' actual service will be 
sufficient, in the majority of cases, to ruin a teacher's 
health. But experience and statistics will not bear this 
statement out, as school teachers enjoy an especially fa- 
vorable place in the tables of expectancy of life. Though 
consumption claims the largest number of victims, even 
tills disease is proportionally less frequent among teachers 
than among persons of any other occupation. Diseases 
of the nervous system rank second, and heart disease 
third, as causes of death. But even so, the Eleventh Cen- 
sus of the United States gives the death rates of male 
teachers as 9.28 per thousand, and of female teachers 4.32 
per thousand, and further says that the death rate of 
teachers is much less than the average rate for all other 
selected occupations. On the whole, then, "we must take 
the rough and the thorny as well as smooth and pleasant, 
and a portion at least of our daily duty must be hard and 
disagreeable, for the mind cannot be strong and healthy 
in perpetual sunshine only, and the most dangerous of 
all states is that of constantly recurring pleasure, ease, 
and prosperity." 



CHAPTER XVTII 

Deff.ctive Children 

In all civilized communities, there will be found a cer- 
tain proportion of children, about one to every five hun- 
dred, who from one cause or another are not the mental 
equals of the average child. 

Seguin defines this class as children in whom is pres- 
ent functional torpidity or backwardness of the nervous 
apparatus, but who are not sufficiently abnormal to be 
classed as idiots or imbeciles. They are commonly 
spoken of as backward children. Among this class there 
are many subdivisions, leading from the one of simple re- 
tarded mental development to well-defined cases of idiocy 
and imbecility. 

A. There is a large class who have no organic or 
functional disease, but who are extremely slow in the 
process of mental unfolding. In school, these are the ex- 
tremely dull pupils who find all forms of mental exertion 
difficult. They are particularly troubled with arithmetic, 
less so with reading and writing. Such children do not 
learn to creep, walk or talk until a much later period than 



Defective Children. 191 

the normal child. At the age of ten years they usually 
have the mentaHty of a child four or five years of age. 
They are apt to be the butt of ridicule of their playmates 
and are often teased and hazed beyond endurance. 

Much can be done in developing- these children under 
proper environment. They should be in a school for 
backward thildren, under the care of a teacher who has 
proper interest and sympathy with them. 

Their progress is necessari'ly slow and the tasks as- 
signed to compensate with their enfeebled brain power 
should not be more than one-fourth the regular tasks. It 
is impossible for one teacher to care for and do justice to 
more than ten such pupils. 

The superintendent of the schools of Batavia, N. Y., 
made use of an interesting experiment for the benefit 
of backward children, which elicited favorable comment 
from the educational and medical professions. Finding 
that a certain proportion of the pupils experienced a 
great mental and physical strain in trying to keep up 
to the ordinary school standard, he put into practice a 
very rational plan to stop, as he said, "this killing of 
children." He advised in every room an extra teacher 
whose sole efforts were to be applied in helping those 
who were constantly behind their regular classes. The 
experiment has been tried elsewhere with the same strik- 
ing success that makes one wonder that so excellent an 
expedient had not long since been in use. 



192 The Hygiene of the Schoolroom. 

The most interesting features of the "Batavian experi- 
ment" are that the scholarship was improved and the 
heahh of the child was noticeably benefited. The mental 
load was made lighter for the child and naturally the 
physical strain was lessened. 

It was found that under the new regime a far greater 
number of pupils each year continued their scfiool work, 
and in the high school six times the former number of 
pupils remained to graduate. The experiment deserves 
especial study and imitation. The matter of expense 
would readily be borne in consideration of the helpful- 
ness and healthfulness that would soon be apparent. 

B. There are those children who are defective by rea- 
son of the loss of one or more of the special senses, — as 
the blind, the deaf and the dumb. Fortunately there are 
provided in all states excellent institutions for the care 
and education of these afflicted ones. With this class of 
defectives far better work will be had when the entire 
control of the child is given up to the institution. 

C. The morally defective are that class in which the 
"moral sense which causes a human being to weigh, con- 
sider and approve or disapprove his own conduct, is 
blunted or absent." 

They are especially difficult to control, not susceptible 
to reproof and training, and punishment in their case is 
of no avail. 



Defective Children. 193 

Maudsley speaks of this class as persons "who are born 
with an entire absence of the moral sense, destitute even 
of the possibility of moral feeling. They are as truly in- 
sensible to the moral relations of life, as deficient in this 
regard as a person color blind is to certain colors, or as 
one who is without ear to music is to the finest harmonies 
of sound." They are ordinarily beings of good physical 
health, but for their own good as well as public good they 
should have the constant and restraining influence of an 
institution. 

D. There is a type with all the special senses, but 
without the power of attention. Such children are sin- 
gularly difficult to instruct, for the most painstaking 
labors and frequently repeated suggestion will be with- 
out avail. 

E. Another class is distinguished by being deficient 
in will power. Nervousness, caused by overstudy and 
overwork, sometimes causes this paralysis of will power, 
and it is often noted at or about the period of puberty. 
This loss of will power is a very constant symptom asso- 
ciated with aggravated forms of hysteria. Such cases 
are capable of great improvement, but only after long 
periods of rest under a helpful regime of exercise and 
fresh air. They are poor subjects for school work and 
very little mental work should be expected of them. 

F. There is another class, comprising children who 
possess normal senses but lack the power of memory, 



194 The Hygiene of the Schoolroom. 

failing to retain even for a short time recent instruction. 
This condition sometimes follows debilitating sicknesses, 
injuries and epilepsy. 

It is a condition most often met with in later child life, 
and has little tendency towards improvement. 

G. There are then the many cases of imbecility and 
idiocy wherein exist defective or arrested cerebral devel- 
opment. 

There is no known means of reorganizing a defective 
brain ; but much good can be done by tactful teachers in 
a properly equipped institution. With many cases of all 
classes enumerated some improvement can be made. 
Many if taken in time can be made to be helpful members 
of society rather than dependents. The ordinary public 
school has no opportunity for training these cases. The 
work must be carried on in special schools or institutions 
under civic aid and civic law. Every city should have 
its school for backward children, every state should have 
its homes for the more helpless and dependent. Many 
of the children are so slightly below the standard that 
they may receive satisfactory training at home supple- 
mented by daily attendance at a special school. The 
training is principally along the physical side; indeed, 
this is the most promising avenue open to improvement. 

Dr. Martin W. Barr, chief of Pennsylvania Training' 
School for Feeble Minded Children, says, "The motto of 
the schools — 'We learn by doing ; the working hand niak- 



Defective Children. 195 

ing strong the working brain,' — shows manual training 
to be the basis of the scheme of development, varied for 
each grade to suit the intelligence." 

In the Elmira Reformatory excellent results are 
reached after this same plan of developing the brain from 
the physical side. The defectives are divided into three 
classes: i, those who are intellectually weak but have 
powers of self-control ; 2, those who are bright but lack- 
ing in self-control, and 3, those who are weak and also 
lacking in self-control. Physical training and manual 
training are the successful means of their improvement, 
which is especially apparent in the second class named. 

Too much must not be expected of any form of train- 
ing for the mentally defective. 

No system can make brains; the improvement will be 
apparent only upon the limited amount that are found at 
hand. 



INDEX 



Accident in the Schoolroom, 179- 

185 
Accommodation, 72 
Adenoids, 86, 87, 93 
Age for entering school, 154 
Air, 19-21 

Alcohol, evil effects of, 164, 165 
AUport, Dr. Frank, on eye and 
ear testing, 76 
Anaemia, 152 
Astigmatism, 74, 77 
Athletics, 169 
Audiometer, invention of, 84 

Backward children, treatment of, 
190, 191 
Barr, Dr. Martin W., 194, 195 
Bathing, 124 
Bathrooms, 8-9 
Bell, Prof. A. Melville, quoted, 

93 
Bell, Dr. A. N., 18 
Biggs, Prof. Herman M., 122 
Blindness, color, 77 
Bowditch, Dr., Observation 
Table compiled by, 56 
Briggs, Richard, 22 
Brown-Sequard, 20 
Burns, treatment of, 182 

Calisthenics, 167 
Cellar, construction of, 5 
Chicken pox, loi, 103, 108 



Cloakrooms, 6 

Cohn, Dr., on short sightedness, 
65, 66, 77 
on types of school- 
books, 79, 80 
Conrad, Dr., 65 

Committee of Fiftj-, report of, 
165 
Consumption, 112, 113 
Corporal punishment, 172-178 
Corridors, 6 
Crippled children, care of, 54 

Deafness, causes of, 82 
Defective children, 190-195 
Diet, 161-166 
Diphtheria, 99, loi, 110 
Diseases, contagious, 98-129 

" school," 108 
Disinfection, methods of, 120, 
121 
Drinking cups, 117 
Drowning, 184, 185 
Durgin, Dr. Samuel H., 136, 137 



Ear, hygiene of, 82-89 
Ely, Dr., scientific researches of, 

6s 
Emmetropia, 74 
Entrances, 6 
Epidemics, 100, 120 
Erysipelas, 99 



197 



198 



Index. 



Examinations, completive, aboli- 
tion of, 158, 159 
Exercise, 167— 171 
Eye, hygiene of the, 64-81 

Fainting, 180 
Earner, Dr., theory of, 37 
Eevers, eruptive, 103 
Fire protection, 13-16 
Fumigation, 8, 120 
Furniture, school, 35-56 

Gutzman, Dr. H., 92 
Gymnastics, 12 

Hartwell, Dr., 93 
Heating, 30-34 

Holmes, Dr. Oliver Wendell, 
quoted, 19 
Hypermetropia, 74 
Hysteria, 153, 181 

Indigestion, 152 
Infantile paralysis, 125 
Influenza, 99 
Insomnia, 152 

Jenner, Edward, 103 
Johnson, Dr. James, 18 

Kellogg, Dr. J. H., quoted, 149- 
151 
Klebs-LoefHer bacilli, 140 



Latrine system, 1 1 
Light, 57-63 

Lincoln, Dr. D. F., 41, 43 
Loring, Dr., 65 



MacKenzie, Sir Morrell, quoted, 

95 
Mann, Horace, quoted, 175, 176 
Massachusetts Law regarding 
school construction, 13-16 
Massachusetts Law regarding 
heating, 34 
Measles, 99, loi, 103, 108 
Medical inspection of schools, 
130-144 
Mitchell, Dr. S. Weir, quoted, 
146, 147 
Modern education and health, 
145-160 
Moore, Dr. John Jay, quoted, 
48-50 
Morrison, Gilbert B., 26, foot- 
note 
Mowrv, Dr. W. A., quoted, 62, 

63 
Mumps, 99, 113 
Myopia, 74 

Nervousness, 153 
Nosebleed, 182 

Odors, 27 
Overwork, 146 



Paget, Charles, 154 
Parkes, Dr. Louis C. Table of 
communicable diseases, 99, 100 
Peck, Governor of Wisconsin, 
quoted, 28, 29 
Pershing, Dr., 94 
Photometer, 62 

Physical training and exercise, 
167-171 



Index. 



199 



Playground, 3 
Plumbing, 10-12 
Potter, Dr. W. W., quoted, 147, 
148 
Prisms, 62 

Recess, 28, 29, 160 
Reynolds, Dr., 136 
Ringworm, 114, 115 
Robson, English authority, cited, 
53.61 
RoUin, French historian, quoted, 
173-175 
Roof-gardens, 6 

St. Vitus Dance, 152, 153 
Scarlet fever, 99, 10 1, 103, 109 
Schamberg, Jay F., 105 
School buildings, construction of, 
4-16 
hours, length of, 154-156 
Schoolyard, laying out of, 3 
Scudder, Dr. Chas. L., 45 
Seguin, 190 

Sickness in the schoolroom, 179- 
185 
Site, 1-3 

Slate and pencil, 79, 119 
Sleep, average amount of, 160 
Smallpox, 99, 101-107 
Snellen test types, 75 
Speech, defects of, 90-97 



Squint (strabismus), 70 
Stairs, construction of, 6 
Stammering, 92 
Study, home, 157 
Stuttering, 92 
Sunstroke, i8i 
Swimming tank, 9 
Sylvester's treatment of asphyxia 
from drowning, 184, 185 

Teacher's Health, the, 186-189 
Temperature, 30, 31, 34 
Tuberculosis, 99, 112, 113 
Types of School Books, 79, 80 
Typhoid fever, 99, 113, 114 
Typhus fever, 99, 114 

Vaccination, compulsory, 103 
Ventilation, 17-29 
Vocal organs, 90-97 

Walls, color of, 63 
Water-closets, 9-12 
Wardrobes, 6-8 
Welch, Dr..W. M., 105 
Wernher, Prof., 103 
Whooping-cough, 99, iii, 112 
Woodbridge, Prof. S. H., 18, 19 
Work, pupil's capacity for, 156, 
157 

Young, Dr. Meredith, 102 



DEC 6 1911 



One copy del. to Cat. Div. 



otc s ^®^- 



